Vaccine

ABSTRACT

The present invention relates to the field of vaccines for protecting against polio, and in particular to combination vaccines for protecting against polio, diphtheria, tetanus, and pertussis diseases. Specifically, vaccines comprising reduced dose inactivated poliovirus are provided

FIELD OF THE INVENTION

The present invention relates to the field of vaccines for protectingagainst polio, and in particular to combination vaccines for protectingagainst polio, diphtheria, tetanus, and pertussis diseases.

BACKGROUND

Combination vaccines (which provide protection against multiplepathogens) are very desirable in order to minimise the number ofimmunisations required to confer protection against multiple pathogens,to lower administration costs, and to increase acceptance and coveragerates. The well-documented phenomenon of antigenic competition (orinterference) complicates the development of multi-component vaccines.Antigenic interference refers to the observation that administeringmultiple antigens often results in a diminished response to certainantigens relative to the immune response observed when such antigens areadministered individually.

Combination vaccines are known which can prevent Bordetella pertussis,Clostridium tetani, Corynebacterium diphtheriae, and optionallyinactivated poliovirus (IPV), and/or Hepatitis B virus, and/orHaemophilus type B infection (see for instance WO 93/24148, WO97/00697and WO2000/030678).

After many years of research the standard dose of polio vaccinesaccepted as effective within the vaccine community today contains 40 Dantigen units of inactivated poliovirus type 1 (Mahoney), 8 D antigenunits of inactivated poliovirus type 2 (MEF-1) and 32 D antigen units ofinactivated poliovirus type 3 (Saukett) (e.g. Infanrix-IPV™).

The present inventors have surprisingly found that reduced doses of IPVcan maintain an adequate or improved level of protection against polio.Such vaccines carry considerable advantages including the ability toprovide more doses of IPV vaccines for the individuals in need thereof.

SUMMARY OF THE INVENTION

Accordingly, the present invention provides various reduced-dose IPVvaccines (which may only have IPV components or may have IPV componentscombined with other antigens).

Accordingly, in one aspect the present invention provides an IPV vaccineof the invention comprising inactivated poliovirus type 1 at a dosegreater than 10 D-antigen units and less than 20 D-antigen units, e.g.11, 12, 13, 14, 15, 16, 17, 18 or 19 D-antigen units.

In one embodiment, the present invention provides an IPV vaccine of theinvention comprising inactivated poliovirus type 3 at a dose of 8-20D-antigen units, e.g. 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20D-antigen units.

In another embodiment, the present invention provides an IPV vaccine ofthe invention comprising inactivated poliovirus type 2 at a dose of 2-4D-antigen units, e.g. 2, 3 or 4 D-antigen units.

In a further embodiment, the present invention provides an IPV vaccineof the invention further comprising diphtheria toxoid and/or tetanustoxoid and/or a pertussis vaccine in the form of killed whole-cell Pwvaccine or acellular pertussis antigens.

In a further aspect, the present invention provides an IPV vaccine ofthe invention which is a thiomersal free DTP-IPV combination vaccinecomprising inactivated poliovirus type 1 at a dose between 10 and 36D-antigen units.

In another embodiment, the present invention provides a thiomersal freeDTP-IPV combination vaccine of the invention comprising inactivatedpoliovirus type 2 at a dose of 2-7 D-antigen units, e.g. 5, 6 or 7D-antigen units.

In another embodiment, the present invention provides a thiomersal freeDTP-IPV combination vaccine of the invention comprising inactivatedpoliovirus type 3 at a dose of 8-29 D-antigen units, e.g. 21, 22, 23,24, 25, 26, 27, 28 or 29 D-antigen units.

In a further embodiment, the vaccines of the present invention may alsocomprise one or more antigens selected from the group consisting of:Hepatitis B surface antigen, Haemophilus influenzae b antigen(s),Neisseria meningitidis A antigen(s), Neisseria meningitidis Cantigen(s), Neisseria meningitidis W antigen(s), Neisseria meningitidisY antigen(s), Neisseria meningitidis B bleb or antigen(s), Hepatitis Aantigen(s) and Salmonella typhi antigen(s), in particular capsularsaccharide antigens from said bacteria.

Methods of making the vaccines of the invention are also provided.

DEFINITIONS

The term “vaccine” is optionally substitutable with the term“immunogenic composition” and vice versa.

“D-antigen units” (also referred to as “international units” or IU): TheD antigenic form of the poliovirus induces protective neutralisingantibodies. D antigen units referred to herein (for instance in thevaccines of the invention) are the measured total D antigen units ofeach unadsorbed bulk IPV antigen type prior to formulation of the finalvaccine which are added in each human dose of formulated vaccine(typically 0.5 mL final volume). Reliable methods of measuring D-antigenunits are well known in the art and are published, for instance, by theEuropean Pharmacopoeia. For instance, D-antigen units may be measuredusing the ELISA test as described in Example 1 (“D-antigenquantification by ELISA”) below. European Pharmacopoeia provides a testsample (European Pharmacopoeia Biological ReferencePreparation—available from Ph. Eur. Secretariat, e.g. Code P 216 0000)for standardisation of such methods between manufacturers (PharmeuropaSpecial Issue, Bio 96-2). Thus the D-antigen unit value is wellunderstood in the art.

The term “dose” herein is typically one administration of the vaccine ofthe invention, which is typically one injection. A typical human dose is0.5 mL. Of course various doses may be administered in a vaccineadministration schedule.

The term “IPV” or a vaccine comprising these components herein isintended to mean inactivated polio virus type 1 (e.g. Mahoney, aspreferably used, or Brunhilde as marketed by Statens Serum Institutunder the name of DiTeKiPol), type 2 (e.g. MEF-1), or type 3 (e.g.Saukett), or a combination of either two or all three of these types. Anexample of a full (or standard) dose (40-8-32 D antigen units of IPVtypes 1, 2 and 3 respectively) IPV vaccine for the purposes of thisinvention could be Poliorix® (GSK Biologicals S.A.). Thus, where it isstated herein that X % of a standard dose of IPV is present in a vaccineof the invention it is meant D-antigen units equating to X % of 40, 8,and/or 32 D-antigen units of IPV types 1, 2 and/or 3 respectively (asmeasured in each bulk IPV antigen type) are formulated within each doseof said vaccine.

The terms “lipopolysaccharide” (LPS) and “lipooligosaccharide” (LOS) areinterchangeable.

The term “saccharide” throughout this specification may indicatepolysaccharide or oligosaccharide and includes both. The capsularsaccharide antigen may be a full length polysaccharide or it may beextended to bacterial ‘sized-saccharides’ and ‘oligosaccharides’ (whichnaturally have a low number of repeat units, or which arepolysaccharides reduced in size for manageability, but are still capableof inducing a protective immune response in a host) which are well knownin the vaccine art (see for instance EP 497525).

The term “nucleic acid” herein can comprise single or double strandeddeoxyribonucleic acid (DNA) or single or double stranded ribonucleicacid (RNA) or a mixture thereof.

The term “component(s)” from a pathogen or “component(s) affordingprotection to such a pathogen” within the vaccines of the inventionherein is intended to mean one or more antigen(s) from that pathogen.

The terms “around” or “approximately” herein are taken to mean±10% ofthe stated value, but should be in keeping with the context of use.

DESCRIPTION OF FIGURES

FIG. 1. Evolution of the Relative Potency (RP) of DTPwSF-HB-IPV “Methodof Production 3” with the IPV Dose.

The potency of reduced dose IPV of the formulations “Method ofproduction 3” was examined in vivo in comparison with referenceformulation (Poliorix formulation and DTPaIPVHB). RP of IPV was measuredat doses 100%, 50%, 25% and 12.5% of standard IPV dose (40/8/32D-antigen units for types 1/2/3).

FIG. 2. Evolution of the Relative Potency (RP) of DTPwSF-HB-IPVFormulation Flow-Sheet.

The potency of reduced dose IPV for both formulations “Method ofproduction 3” and “Method of production 4” was examined in vivo incomparison with reference formulations (Poliorix formulation andDTPaIPVHB). RP was measured for both “Method of production 3” and“Method of production 4” at 25% of the standard IPV dose (40/8/32D-antigen units for types 1/2/3) in comparison to a placebo with 25% ofIPV alone.

FIG. 3. Relative Potency of IPV Types 1, 2 and 3 at Time 0 and 8 Months.

Relative potency of IPV was measured [relative to DTPaHBIPV (Pediarix)(FIG. 3 a) or Poliorix (FIG. 3 b)] to determine whether the Hibcomponent has an effect on IPV potency and to evaluate the stability ofIPV over time at different IPV doses.

DETAILED DESCRIPTION

The present invention provides a vaccine (e.g. a combination vaccine)comprising antigens from poliovirus (IPV) and optionally Corynebacteriumdiphtheriae (D), Clostridium tetani (T), Bordetella pertussis (P) orHepatitis B.

The Antigens of the Invention IPV Vaccine Components

Vaccines of the invention may be comprised of IPV type 1 or IPV type 2or IPV type 3, or IPV types 1 and 2, or IPV types 1 and 3, or IPV types2 and 3, or IPV types 1, 2 and 3.

Methods of preparing inactivated poliovirus (IPV) are well known in theart. In one embodiment, IPV should comprise types 1, 2 and 3 as iscommon in the vaccine art, and may be the Salk polio vaccine which isinactivated with formaldehyde (see for example, Sutter et al., 2000,Pediatr. Clin. North Am. 47:287; Zimmerman & Spann 1999, Am FamPhysician 59:113; Salk et al., 1954, Official Monthly Publication of theAmerican Public Health Association 44(5):563; Hennesen, 1981, Develop.Biol. Standard 47:139; Budowsky, 1991, Adv. Virus Res. 39:255).

In one embodiment the IPV is not adsorbed (e.g. before mixing with othercomponents if present). In another embodiment, the IPV component(s) ofthe invention may be adsorbed onto an aluminium salt such as aluminiumhydroxide (e.g. before or after mixing with other components ifpresent). In another embodiment, the IPV component(s) of the inventionmay be adsorbed onto an aluminium salt such as aluminium phosphate. In afurther embodiment the IPV component(s) may be adsorbed onto a mixtureof both aluminium hydroxide and aluminium phosphate. If adsorbed, one ormore IPV components may be adsorbed separately or together as a mixture.IPV may be stabilised by a particular drying process as described inWO2004/039417.

Poliovirus may be grown in cell culture. The cell culture may be a VEROcell line or PMKC, which is a continuous cell line derived from monkeykidney. VERO cells can conveniently be cultured microcarriers. Cultureof the VERO cells before and during viral infection may involve the useof bovine-derived material, such as calf serum, and this material shouldbe obtained from sources which are free from bovine spongiformencephalitis (BSE). Culture may also involve materials such aslactalbumin hydrolysate. After growth, virions may be purified usingtechniques such as ultrafiltration, diafiltration, and chromatography.Prior to administration to patients, the viruses must be inactivated,and this can be achieved by treatment with formaldehyde.

Viruses may be grown, purified and inactivated individually, and thencombined to give a concentrate bulk mixture for IPV vaccine use or foraddition to the adsorbed diphtheria and tetanus antigen and pertussiscomponents for DTPw-IPV or DTPa-IPV comprising vaccines.

Antigens in vaccines of the invention will be present in“immunologically effective amounts” i.e. the administration of thatamount to an individual, either in a single dose or as part of a series,is effective for treatment or prevention of disease. Dosage treatmentmay be a single dose schedule or a multiple dose schedule (e.g.including booster doses).

Standard doses of polio vaccines today tend to contain 40 D antigenunits of inactivated poliovirus type 1, 8 D antigen units of inactivatedpoliovirus type 2 and 32 D antigen units of inactivated poliovirus type3 (e.g. Infanrix-IPV™).

However, the present inventors have surprisingly found that reduceddoses of IPV can be used to obtain a good immune response. In oneembodiment, an IPV vaccine dose of the present invention may comprisebetween 10 and 36 D-antigen units of IPV type 1 (e.g. 11-32, 12-28,13-24, 14-20 or 15-19 D-antigen units). In another embodiment, an IPVvaccine dose of the present invention may comprise IPV type 1 at a doseof 10-20 D-antigen units or a dose greater than 10 D-antigen units andless than 20 D-antigen units. In another embodiment, a vaccine dose ofthe present invention may comprise 26-49%, 30-45%, 33-40%, 35-37%, orapproximately or exactly one third of a standard 40 D-antigen unit doseof IPV type 1 (equivalent to approximately 10.4-19.6, 12-18, 13.2-16,14-14.8 or 13.3 D-antigen units). In another embodiment, an IPV vaccinedose of the present invention may comprise 11-32 D-antigen units, 12-28D-antigen units, 13-24 D-antigen units or 14-20 D-antigen units of IPVtype 1.

Alternatively, an IPV vaccine dose of the present invention may comprise10-19.5 D-antigen units, 12-19 D-antigen units, 14-18.5 D-antigen units,or 15-17 D-antigen units; for instance around or exactly 16 D-antigenunits of IPV type 1.

In a further embodiment, the vaccines of the present invention maycomprise less than 4 D-antigen units, 2-4 D-antigen units (equivalent to25-50% of a standard 8 D-antigen unit dose) or around or exactly 3D-antigen units of IPV type 2 (equivalent to 37.5% of a standard 8D-antigen unit dose).

In another embodiment, the vaccine of the present invention may compriseapproximately or exactly one third of a standard 8 D-antigen unit doseof IPV type 2 (equivalent to approximately 2.7 D-antigen units).

In a further embodiment, the vaccines of the present invention maycomprise 2-7 D-antigen units of IPV type 2. In another embodiment, anIPV vaccine dose of the present invention may comprise 3-6 D-antigenunits, or 4-5 D-antigen units of IPV type 2.

Alternatively, an IPV vaccine dose of the present invention may comprise2-4.5 D-antigen units, 2.5-4 D-antigen units or 3-3.5 D-antigen units ofIPV type 2.

In a further embodiment the vaccines of the present invention maycomprise 8-20 D-antigen units, more than 8 and less than 20 D-antigenunits, 9-19 D-antigen units, 10-18 D-antigen units, 11-17 D-antigenunits, 12-16 D-antigen units, or 13-15 D-antigen units; for instancearound or exactly 14 D-antigen units of IPV type 3 (equivalent to25-62.5%, 28.125-59.375%, 31.25-46.875% or 43.75% of a standard 32D-antigen unit dose).

In another embodiment, the vaccine of the present invention may compriseapproximately or exactly one third of a standard 32 D-antigen unit doseof IPV type 3 (equivalent to approximately 10.7 D-antigen units).

In a further embodiment, an IPV vaccine dose of the present inventionmay comprise 8-29 D-antigen units, 9-26 D-antigen units, 10-23 D-antigenunits, 11-20 D-antigen units, 12-17 D-antigen units, or 13-14 D-antigenunits of IPV type 3.

Alternatively, an IPV vaccine dose of the present invention may comprise8-19.5 D-antigen units, 9-19 D-antigen units, 10-18.5 D-antigen units,11-18 D-antigen units, 12-17.5 D-antigen units, 13-17 D-antigen units,or 14-16 D-antigen units; for instance around or exactly 15 D-antigenunits.

DTP Vaccine Components

DTP vaccines are well known vaccines to prevent or treat diphtheria,tetanus and B. pertussis disease. The vaccines of the invention maycomprise diphtheria, tetanus and/or pertussis component(s).

The diphtheria antigen is typically a diphtheria toxoid. The preparationof diphtheria toxoids (DT) is well documented. Any suitable diphtheriatoxoid may be used. For instance, DT may be produced by purification ofthe toxin from a culture of Corynebacterium diphtheriae followed bychemical detoxification, but is alternatively made by purification of arecombinant, or genetically detoxified analogue of the toxin (forexample, CRM197, or other mutants as described in U.S. Pat. No.4,709,017, U.S. Pat. No. 5,843,711, U.S. Pat. No. 5,601,827, and U.S.Pat. No. 5,917,017). In one embodiment DT is present at an amount of5-50, 7-30 Lf or approximately or exactly 7.5 Lf or 25 Lf per 0.5 mLdose. In a further embodiment DT is present at a low dose of less than 5Lf, or 1-4 Lf or approximately or exactly 2 Lf per 0.5 mL dose. In oneembodiment, the diphtheria toxoid of the invention may be adsorbed ontoan aluminium salt such as aluminium hydroxide. In another embodiment,the diphtheria toxoid of the invention may be adsorbed onto an aluminiumsalt such as aluminium phosphate. In a further embodiment the diphtheriatoxoid may be adsorbed onto a mixture of both aluminium hydroxide andaluminium phosphate.

The tetanus antigen of the invention is typically a tetanus toxoid.Methods of preparing tetanus toxoids (TT) are well known in the art. Inone embodiment TT is produced by purification of the toxin from aculture of Clostridium tetani followed by chemical detoxification, butis alternatively made by purification of a recombinant, or geneticallydetoxified analogue of the toxin (for example, as described in EP209281). Any suitable tetanus toxoid may be used. ‘Tetanus toxoid’ mayencompass immunogenic fragments of the full-length protein (for instanceFragment C—see EP 478602). In one embodiment TT is present at an amountof 2.5-30 Lf, 3-20 Lf, 5-15 Lf or exactly or approximately 10 Lf per 0.5mL dose. In one embodiment, the tetanus toxoid of the invention may beadsorbed onto an aluminium salt such as aluminium hydroxide. In anotherembodiment, the tetanus toxoid of the invention may be adsorbed onto analuminium salt such as aluminium phosphate. In a further embodiment thetetanus toxoid may be adsorbed onto a mixture of both aluminiumhydroxide and aluminium phosphate.

The pertussis component of the invention may be either acellular (Pa)where purified pertussis antigens are used or whole-cell (Pw) wherekilled whole cell pertussis is used as the pertussis component. Pw maybe inactivated by several known methods, including mercury free methods.Such methods may include heat (e.g. 55-65° C. or 56-60° C., for 5-60minutes or for 10-30 minutes, e.g. 60° C. for 30 minutes), formaldehyde(e.g. 0.1% at 37°, 24 hours), glutaraldehyde (e.g. 0.05% at roomtemperature, 10 minutes), acetone-I (e.g. three treatments at roomtemperature) or acetone-II (e.g. three treatments at room temperatureand fourth treatment at 37° C.) inactivation (see for example Gupta etal., 1987, J. Biol. Stand. 15:87; Gupta et al., 1986, Vaccine, 4:185).Methods of preparing killed, whole-cell Bordetella pertussis (Pw)suitable for this invention are disclosed in WO 93/24148, as aresuitable formulation methods for producing DT-TT-Pw-HepB vaccines.Thiomersal has been used in the past in the preparation of killedwhole-cell Bordetella pertussis (see below). However, in one embodimentit is not used in the formulation process of the vaccines of the presentinvention.

A Pw dose of 5-50 IOU, 7-40 IOU, 9-35 IOU, 11-30 IOU, 13-25 IOU, 15-21IOU or around or exactly 20 IOU is typically used.

Acellular Pa vaccines are also well known, and may comprise 2 or moreantigens from: pertussis toxoid (PT), filamentous haemagglutinin (FHA),pertactin (PRN), agglutinogens 2 & 3. In one embodiment, the Pa vaccinecomprises PT, FHA and PRN. Kits or vaccines of the invention maycomprise PT detoxified by a well known method of formaldehyde treatmentor by means of mutations (PT derivative). Substitutions of residueswithin the S1 subunit of the protein have been found to result in aprotein which retains its immunological and protective properties of thePT, but with reduced or no toxicity (EP 322533). The detoxifyingmutations discussed in the claims of EP322533 are examples of the DTdetoxified mutants of the present invention. Such mutants may be used atdoses lower than 20-25 μg.

In one embodiment PT is used at an amount of 2-50 μg, 5-40 μg, 10-30 μgor exactly or approximately 25 μg per 0.5 mL dose. In another embodimentPT is used at an amount of exactly or approximately 2.5 or 8 μg per 0.5mL dose.

In one embodiment FHA is used at an amount of 2-50 μg, 5-40 μg, 10-30 μgor exactly or approximately 25 μg per 0.5 mL dose. In another embodimentFHA is used at an amount of exactly or approximately 2.5 or 8 μg per 0.5mL dose.

In one embodiment PRN is used at an amount of 0.5-20 μg, 0.8-15 μg, 2-10μg or exactly or approximately 8 μg per 0.5 mL dose. In anotherembodiment PRN is used at an amount of exactly or around 0.8 or 2.5 μgper 0.5 mL.

In one embodiment, the pertussis component of the invention may beadsorbed onto an aluminium salt such as aluminium hydroxide. In anotherembodiment, the pertussis component of the invention may be adsorbedonto an aluminium salt such as aluminium phosphate. In a furtherembodiment the pertussis component may be adsorbed onto a mixture ofboth aluminium hydroxide and aluminium phosphate. For instance in oneembodiment at least PRN is adsorbed onto aluminium hydroxide with PT/FHAadsorbed onto aluminium hydroxide, aluminium phosphate or a mixture ofboth.

Further Antigens

Vaccine formulations of the invention, optionally also comprising DTP(DTPw or DTPa), can additionally comprise one or more antigens selectedfrom the group consisting of: Hepatitis B surface antigen, Haemophilusinfluenzae b antigen(s), Neisseria meningitidis A antigen(s), Neisseriameningitidis C antigen(s), Neisseria meningitidis W-135 antigen(s),Neisseria meningitidis Y antigen(s), Neisseria meningitidis B bleb orpurified antigen(s), Hepatitis A antigen(s), Salmonella typhi antigen(s)and RTS,S. Typically the capsular saccharide or LOS antigens of thesepathogens may be used. Antigens will typically be present at aconcentration of at least 1 μg/mL each, for instance 1-20 μg/mL, 2-15μg/mL, 2.5-10 μg/mL, 3-8 μg/mL, or 4-6 μg/mL. In general, theconcentration of any antigen will be sufficient to elicit an immuneresponse against that antigen. It is preferred that the protectiveefficacy of individual antigens is not removed by combining them,although actual immunogenicity (e.g. ELISA titres) may be reduced.

The further antigen(s) may in one embodiment of the invention beadsorbed onto an aluminium salt such as aluminium hydroxide. In anotherembodiment, the further antigens of the invention may be adsorbed ontoan aluminium salt such as aluminium phosphate. In a further embodimentthe further antigens may be adsorbed onto a mixture of both aluminiumhydroxide and aluminium phosphate, or may be unadsorbed.

Where a capsular saccharide or LOS antigen is used it may be conjugatedto a carrier protein comprising T helper epitopes in order to enhanceimmunogenicity. The invention may also comprise free “carrier proteins”.

As an alternative to using protein antigens in the compositions of theinvention, nucleic acid encoding the antigen may be used. Proteincomponents of the compositions of the invention may thus be replaced bynucleic acid (for instance DNA, which may be in the form of a plasmid)that encodes the protein. Similarly, compositions of the invention maycomprise proteins which mimic saccharide antigens e.g. mimotopes oranti-idiotype antibodies. These may replace individual saccharidecomponents, or may supplement them.

Hepatitis B Antigen

The preparation of Hepatitis B surface antigen (HBsAg) is welldocumented. See for example, Hartford et al., 1983, Develop. Biol.Standard 54:125, Gregg et al., 1987, Biotechnology 5:479, EP0226846,EP0299108. It may be prepared as follows. One method involves purifyingthe antigen in particulate form from the plasma of chronic hepatitis Bcarriers, as large quantities of HBsAg are synthesised in the liver andreleased into the blood stream during an HBV infection. Another methodinvolves expressing the protein by recombinant DNA methods. The HBsAgmay be prepared by expression in the Saccharomyces cerevisiae yeast,pichia, insect cells (e.g. Hi5) or mammalian cells. The HBsAg may beinserted into a plasmid, and its expression from the plasmid may becontrolled by a promoter such as the “GAPDH” promoter (from theglyceraldehyde-3-phosphate dehydrogenase gene). The yeast may becultured in a synthetic medium. HBsAg can then be purified by a processinvolving steps such as precipitation, ion exchange chromatography, andultrafiltration. After purification, HBsAg may be subjected to dialysis(e.g. with cysteine). The HBsAg may be used in a particulate form.

As used herein the expression “Hepatitis B surface antigen” or “HBsAg”includes any HBsAg antigen or fragment thereof displaying theantigenicity of HBV surface antigen. It will be understood that inaddition to the 226 amino acid sequence of the HBsAg S antigen (seeTiollais et al., 1985, Nature 317:489 and references therein) HBsAg asherein described may, if desired, contain all or part of a pre-Ssequence as described in the above references and in EP0278940. Inparticular, the HBsAg may comprise a polypeptide comprising an aminoacid sequence comprising residues 133-145 followed by residues 175-400of the L-protein of HBsAg relative to the open reading frame on aHepatitis B virus of ad serotype (this polypeptide is referred to as L*;see EP0414374). HBsAg within the scope of the invention may also includethe preS1-preS2-S polypeptide described in EP0198474 (Endotronics) oranalogues thereof such as those described in EP0304578 (McCormick andJones) HBsAg as herein described can also refer to mutants, for examplethe “escape mutant” described in WO 91/14703 or EP0511855A1, especiallyHBsAg wherein the amino acid substitution at position 145 is to argininefrom glycine.

The HBsAg may be in particle form. The particles may comprise forexample S protein alone or may be composite particles, for example L*,S) where L* is as defined above and S denotes the S-protein of HBsAg.The said particle is advantageously in the form in which it is expressedin yeast.

In one embodiment, HBsAg is the antigen used in EngerixB™(GlaxoSmithKline Biologicals S.A.), which is further described inWO93/24148.

In one embodiment, HBsAg is present at an amount of 5-20 μg, 8-15 μg orapproximately or exactly 10 μg per 0.5 mL dose.

Hepatitis B surface antigen may be adsorbed onto aluminium phosphate,which may be done before mixing with the other components (described inWO93/24148). The Hepatitis B component should be substantiallythiomersal free (method of preparation of HBsAg without thiomersal hasbeen previously published in EP1307473).

Haemophilus influenzae b Antigen(s)

Vaccines comprising antigens from Haemophilus influenzae type B havebeen described in WO97/00697. The vaccines of the invention may use anysuitable Haemophilus influenzae type B antigen. The antigen may becapsular saccharide (PRP) from Haemophilus influenzae type B conjugatedto a carrier protein (Hib). The saccharide is a polymer of ribose,ribitol and phosphate. The Hib antigen may optionally be adsorbed ontoaluminium phosphate as described in WO97/00697, or may be unadsorbed asdescribed in WO02/00249 or may not have undergone a specific process ofadsorption.

By an antigen being ‘unadsorbed onto an aluminium adjuvant salt’ hereinit is meant for example that an express or dedicated adsorption step forthe antigen on fresh aluminium adjuvant salt is not involved in theprocess of formulating the composition.

Hib may be conjugated to any carrier which can provide at least oneT-helper epitope (examples of which are described below), and may betetanus toxoid, diphtheria toxoid, CRM-197 (diphtheria toxin mutant) orProtein D.

Hib may be lyophilised and may be reconstituted extemporaneously (e.g.with diluent, optionally comprising other antigenic components of thevaccines of the invention).

In one embodiment, Hib is present at an amount of 5-20 μg, 8-15 μg orapproximately or exactly 10 μg saccharide per 0.5 mL dose.

In a further embodiment, Hib is present at a low dose (e.g. 1-6 μg, 2-4μg or around or exactly 2.5 μg saccharide) as described in WO 02/00249.

Neisseria meningitidis Types A, C, W or Y Antigens

The vaccines of the invention may further comprise a capsular saccharideof a bacterium selected from the group consisting of N. meningitidistype A (MenA, optionally conjugated to a carrier protein), N.meningitidis type C (MenC, optionally conjugated to a carrier protein),N. meningitidis type W-135 (MenW, optionally conjugated to a carrierprotein), and N. meningitidis type Y (MenY, optionally conjugated to acarrier protein).

The vaccines of the invention may comprise one or more antigens from thedifferent strains of N. meningitidis, which may be used alone or in anycombination of two, three or four components as detailed below:

MenA, MenC, MenW, MenY, or MenA+MenC, MenA+MenW, MenA+MenY, MenC+MenW,MenC+MenY, MenW+MenY or MenA+MenC+MenW, MenA+MenC+MenY, MenA+MenW+MenY,MenC+MenW+MenY or MenA+MenC+MenW+MenY.

In one embodiment, the Neisseria meningitidis component(s) of theinvention may be adsorbed onto an aluminium salt such as aluminiumhydroxide. In another embodiment, the Neisseria meningitidiscomponent(s) of the invention may be adsorbed onto an aluminium saltsuch as aluminium phosphate. In a further embodiment the Neisseriameningitidis component(s) may be adsorbed onto a mixture of bothaluminium hydroxide and aluminium phosphate. In one embodiment theNeisseria meningitidis component(s) may be unadsorbed onto an adjuvant,e.g. an aluminium adjuvant salt.

Neisseria meningitidis Type B Bleb or Antigen(s)

The vaccines of the invention may also comprise a MenB component such asan outer membrane vesicle or bleb as described in WO01/09350,WO03/105890, WO04/014417, or WO04/014418 or a conjugated MenB capsularsaccharide (or derivative thereof) antigen (e.g. see WO 96/40239) or afree or conjugated L2 or L3 or L2 and L3 meningococcal LOS (as per WO2004/014417). In one embodiment, the MenB component(s) of the inventionmay be adsorbed onto an aluminium salt such as aluminium hydroxide. Inanother embodiment, the MenB component(s) of the invention may beadsorbed onto an aluminium salt such as aluminium phosphate. In afurther embodiment the MenB component(s) may be adsorbed onto a mixtureof both aluminium hydroxide and aluminium phosphate. In one embodimentthe MenB component(s) may be unadsorbed onto an adjuvant, e.g. analuminium adjuvant salt.

Salmonella typhi Antigen(s)

The vaccines of the invention may further comprise the Vi saccharidefrom Salmonella typhi, which may be the registered product Typherix®,described in EP1107787, or a conjugate thereof (e.g. with a carrierprotein as described herein). The conjugation process may be carried outas described in WO 2007/000343. In one embodiment, the Vi saccharide(s)of the invention may be adsorbed onto an aluminium salt such asaluminium hydroxide. In another embodiment, the Vi saccharide(s) of theinvention may be adsorbed onto an aluminium salt such as aluminiumphosphate. In a further embodiment the Vi saccharide(s) may be adsorbedonto a mixture of both aluminium hydroxide and aluminium phosphate. Inone embodiment the Vi saccharide(s) may be unadsorbed onto an adjuvant,e.g. an aluminium adjuvant salt.

Hepatitis A Antigen(s)

The component affording protection against Hepatitis A may be a killedattenuated Hepatitis A vaccine, for example the product known as Havrix™(Registered Trade Mark of GlaxoSmithKline Biologicals S.A.) which is akilled attenuated vaccine derived from the HM-175 strain of Hepatitis Avirus (HAV) (see “Inactivated Candidate Vaccines for Hepatitis A” by F.E. Andre et al., 1980, Prog. Med. Virol. 37:72 and the product monograph“Havrix” published by SmithKline Beecham Biologicals 1991). Flehmig etal. (1990, Prog. Med. Virol. 37:56) have reviewed the clinical aspects,virology, immunology and epidemiology of Hepatitis A and discussedapproaches to the developments of vaccines against this common viralinfection. As used herein the expression “HAV antigen” refers to anyantigen capable of stimulating neutralising antibody to HAV in humans.In one embodiment the HAV antigen comprises inactivated attenuated virusparticles, or in another embodiment it may be a HAV capsid or HAV viralprotein, which may conveniently be obtained by recombinant DNAtechnology. In one embodiment, the Hepatitis A component of theinvention may be adsorbed onto an aluminium salt such as aluminiumhydroxide. In another embodiment, the Hepatitis A component of theinvention may be adsorbed onto an aluminium salt such as aluminiumphosphate. In a further embodiment the Hepatitis A component may beadsorbed onto a mixture of both aluminium hydroxide and aluminiumphosphate.

Malarial Antigen(s)

The vaccines of the invention may further comprise Malarial antigen(s).The Malarial antigen may be RTS,S (hybrid protein between CS andHBsAg—described in U.S. Pat. No. 6,306,625 and EP 0614465). In oneembodiment, RTS,S may be used in the vaccines of the invention in placeof HBsAg. Other Malarial antigens may also be used in the vaccines ofthe invention, including CS protein, RTS, TRAP, 16 kD protein of B 2992,AMA-1, MSP1, optionally including CpG (WO2006/029887, WO98/05355,WO01/00231).

In one embodiment, the Malarial antigen(s) of the invention may beadsorbed onto an aluminium salt such as aluminium hydroxide. In anotherembodiment, the Malarial antigen(s) of the invention may be adsorbedonto an aluminium salt such as aluminium phosphate. In a furtherembodiment the Malarial antigen(s) may be adsorbed onto a mixture ofboth aluminium hydroxide and aluminium phosphate. In one embodiment theMalarial antigen is adjuvanted with an oil-in-water emulsion and/orlipid A derivative (such as MPL) and or sterol (such as cholesterol)and/or tocol (such as α-tocopherol) In another embodiment the Malariaantigen(s) may be unadsorbed onto an adjuvant, e.g. an aluminiumadjuvant salt.

Conjugates

Bacterial capsular saccharide conjugates of the invention may compriseany carrier peptide, polypeptide or protein comprising at least oneT-helper epitope. The carrier protein(s) used may be selected from thegroup consisting of: tetanus toxoid, diphtheria toxoid, CRM197,recombinant diphtheria toxin (as described in any of U.S. Pat. No.4,709,017, WO 93/25210, WO 95/33481, or WO 00/48638), pneumolysin(optionally chemically detoxified, or a detoxified mutant) from S.pneumoniae (see e.g. WO 2004/081515 and references referred to therein),OMPC from N. meningitidis (EP 0372501), and protein D (PD) from H.influenzae (EP 594610). Other carriers may include synthetic peptides(EP 0378881; EP 0427347), heat shock proteins (WO 93/17712; WO94/03208), pertussis proteins (WO 98/58668; EP 0471177), cytokines (WO91/01146), lymphokines (WO 91/01146), hormones (WO 91/01146), growthfactors (WO 91/01146), artificial proteins comprising multiple humanCD4⁺ T cell epitopes from various pathogen-derived antigens (Falugi etal., 2001, Eur. J. Immunol. 31:3816), pneumococcal surface protein PspA(WO 02/091998), iron uptake proteins (WO 01/72337), toxin A or B from C.difficile (WO 00/61761), pneumococcal PhtD (WO 00/37105), pneumococcalPhtDE (e.g. WO 01/98334 & WO 03/054007), PhtX, etc.

Saccharides may all be on the same carrier, particularly all saccharidesfrom a particular organism, for instance MenA, MenC, MenW and MenYsaccharides may all be conjugated to TT, DT or CRM-197. However, due tothe known effect of carrier suppression, it may be advantageous if ineach of the compositions of the invention the saccharide antigenscontained therein (‘n’ antigens) are conjugated to more than onecarrier. Thus (n−1) of the saccharides could be carried (separately) onone type of carrier, and 1 on a different carrier, or (n−2) on one, and2 on two different carriers, etc. For example, in a vaccine containing 4bacterial saccharide conjugates, 1, 2 or all four could be conjugated todifferent carriers). Protein D, however, may be used for various (2, 3,4 or more) saccharides in a composition without a marked carriersuppression effect. Hib may be present as a TT, DT or CRM197 conjugate,and MenA, MenC, MenY and MenW may be either TT, DT, CRM197 or PDconjugates. Vi may be present as a TT, DT or CRM197 conjugate. Protein Dis a useful carrier as it provides a further antigen which can provideprotection against H. influenzae. In one embodiment, all saccharides areconjugated to the same carrier protein.

Vi may be conjugated to a carrier protein for instance by a method usingcarbodiimide (e.g. EDAC) condensation chemistry (given that the Virepeat subunit comprises carboxylic acid groups). This could be achievedeither by (i) a single carbodiimide reaction between COOH of Vi and NH2of protein or (ii) a double carbodiimide reaction which can occur eitherbetween COOH of Vi and NH2 of a homobifunctional linker molecule andCOOH of protein and NH2 of the homobifunctional linker molecule, orbetween COOH of Vi and NH2 of the heterobifunctional linker molecule andNH2 of protein and COOH of the heterobifunctional linker molecule.

Conjugation may be used in conjunction with free carrier protein(s). Inone embodiment, when a given carrier protein is present in both free andconjugated form in a composition of the invention, the unconjugated formis no more than 5% of the total amount of the carrier protein in thecomposition as a whole, or in another embodiment is present at less than2% by weight.

The saccharide may be linked to the carrier protein by any known method(for example, by Likhite, U.S. Pat. No. 4,372,945 and by Armor et al.,U.S. Pat. No. 4,474,757), with any suitable linker where necessary.

The saccharide will typically be activated or functionalised prior toconjugation. Activation may involve, for example, cyanylating agentssuch as CDAP (1-cyano-dimethylaminopyridinium tetrafluoroborate) (WO95/08348 & WO 96/29094). The cyanilation reaction can be performed underrelatively mild conditions, which avoids hydrolysis of the alkalinesensitive saccharides. This synthesis allows direct coupling to acarrier protein. Other suitable techniques use carbodiimides,hydrazides, active esters, norborane, p-nitrobenzoic acid,N-hydroxysuccinimide, S-NHS, EDC or TSTU.

Linkages via a linker group may be made using any known procedure, forexample, the procedures described in U.S. Pat. No. 4,882,317 and U.S.Pat. No. 4,695,624. One type of linkage involves reductive amination ofthe saccharide, coupling the resulting amino group with one end of anadipic acid linker group (EP 0477508, Porro et al., 1985, Mol. Immunol.22:907, EP 0208375), and then coupling a protein to the other end of theadipic acid linker group. Other linkers include B-propionamido (WO00/10599), nitrophenyl-ethylamine (Gever et al., 1979, Med. Microbiol.Immunol. 165:171), haloacyl halides (U.S. Pat. No. 4,057,685),glycosidic linkages (U.S. Pat. No. 4,673,574; U.S. Pat. No. 4,761,283;U.S. Pat. No. 4,808,700), 6-aminocaproic acid (U.S. Pat. No. 4,459,286),ADH (U.S. Pat. No. 4,965,338), C4 to C12 moieties (U.S. Pat. No.4,663,160), etc. As an alternative to using a linker, direct linkage canbe used. Direct linkages to the protein may comprise oxidation of thesaccharide followed by reductive amination with the protein, asdescribed in, for example U.S. Pat. No. 4,761,283 and U.S. Pat. No.4,356,170 or a direct CDAP reaction.

After conjugation, free and conjugated saccharides can be separated.There are many suitable methods for this separation, includinghydrophobic chromatography, tangential ultrafiltration, diafiltration,etc (see also Lei et al., 2000, Dev Biol. (Basel). 103:259; WO 00/38711;U.S. Pat. No. 6,146,902). In one embodiment, if a vaccine comprises agiven saccharide in both free and conjugated forms, the unconjugatedform is no more than 20% by weight of the total amount of thatsaccharide in the composition as a whole (e.g. ≦15%, ≦10%, ≦5%, ≦2%,≦1%).

An amount of saccharide which is capable of conferring protection to ahost (an effective amount) can be determined by the skilled person. Inone embodiment, each dose will comprise 0.1-100 μg of saccharide, inanother embodiment each dose will comprise 0.1-50 μg, in a furtherembodiment each dose will comprise 0.1-10 μg, in yet another embodimenteach dose will comprise 1 to 5 μg.

Adjuvants

The vaccines of the invention may include a pharmaceutically acceptableexcipient such as a suitable adjuvant. Suitable adjuvants include analuminium salt such as aluminium hydroxide or aluminium phosphate, butmay also be a salt of calcium, iron or zinc, or may be an insolublesuspension of acylated tyrosine, or acylated sugars, or may becationically or anionically derivatised saccharides, polyphosphazenes,biodegradable microspheres, monophosphoryl lipid A (MPL), lipid Aderivatives (e.g. of reduced toxicity), 3-O-deacylated MPL, quil A,Saponin, QS21, tocol (EP 0382271), Freund's Incomplete Adjuvant (DifcoLaboratories, Detroit, Mich.), Merck Adjuvant 65 (Merck and Company,Inc., Rahway, N.J.), AS-2 (Smith-Kline Beecham, Philadelphia, Pa.), CpGoligonucleotides, bioadhesives and mucoadhesives, microparticles,liposomes, polyoxyethylene ether formulations, polyoxyethylene esterformulations, muramyl peptides or imidazoquinolone compounds (e.g.imiquamod and its homologues). Human immunomodulators suitable for useas adjuvants in the invention include cytokines such as interleukins(e.g. IL-1, IL-2, IL-4, IL-5, IL-6, IL-7, IL-12, etc), macrophage colonystimulating factor (M-CSF), tumour necrosis factor (TNF), granulocyte,macrophage colony stimulating factor (GM-CSF) may also be used asadjuvants.

In one embodiment of the invention, the adjuvant composition of theformulations induces an immune response predominantly of the TH1 type.High levels of TH1-type cytokines (e.g. IFN-γ, TNFα, IL-2 and IL-12)tend to favour the induction of cell mediated immune responses to anadministered antigen. Within one embodiment, in which a response ispredominantly TH1-type, the level of TH1-type cytokines will increase toa greater extent than the level of TH2-type cytokines. The levels ofthese cytokines may be readily assessed using standard assays. For areview of the families of cytokines, see Mosmann and Coffman, 1989, Ann.Rev. Immunol. 7:145.

Accordingly, suitable adjuvant systems which promote a predominantly TH1response include, derivatives of lipid A (e.g. of reduced toxicity),Monophosphoryl lipid A (MPL) or a derivative thereof, particularly3-de-O-acylated monophosphoryl lipid A (3D-MPL), and a combination ofmonophosphoryl lipid A, optionally 3-de-O-acylated monophosphoryl lipidA together with an aluminium salt. An enhanced system involves thecombination of a monophosphoryl lipid A and a saponin derivative,particularly the combination of QS21 and 3D-MPL as disclosed in WO94/00153, or a less reactogenic composition where the QS21 is quenchedwith cholesterol as disclosed in WO 96/33739. A particularly potentadjuvant formulation involving QS21, 3D-MPL and tocopherol in an oil inwater emulsion is described in WO 95/17210. The vaccine may additionallycomprise a saponin, which may be QS21. The formulation may also comprisean oil in water emulsion and tocopherol (WO 95/17210). Unmethylated CpGcontaining oligonucleotides (WO 96/02555) are also preferential inducersof a TH1 response and are suitable for use in the present invention.

The vaccines of the invention may also comprise combinations of aspectsof one or more of the adjuvants of the invention identified above.

Any adjuvant of the invention can be adsorbed by or combined with IPVcomponent of the invention.

When referring to aluminium hydroxide or aluminium phosphate, referenceis made to all aluminium hydroxide and or aluminium phosphate adjuvantsas described by Hem and White (Pharm Biotechnol. 1995; 6:249-276).

In one embodiment, aluminium phosphate may also be referred to asaluminium hydroxyphosphate. In another embodiment, aluminium phosphatehas a negative charge at a pH of 7.4. Typically, the isoelectric point(pI) of aluminium phosphate is 5-7, or 6-7 or around or exactly 5. In afurther embodiment, aluminium phosphate has a molar phosphate:aluminiumratio of 0.3-0.9, or 0.3-0.6, or 0.8-0.9.

In one embodiment, aluminium hydroxide has a positive charge at a pH of7.4. Typically, the pI of aluminium hydroxide is 8-11, 9-11, 10-11 oraround or exactly 11.

Typically, the total aluminium content is 200-1000 μg, 300-900 μg,400-800 μg, 500-700 μg or around or exactly 630 μg Al³⁺ per 0.5 mL dose.This may be all aluminium hydroxide or all aluminium phosphate.Alternatively Al³⁺ content may be from a mixture of aluminium hydroxideand aluminium phosphate in the following ratio: 1:8-8:1, 1:4-4:1,3:8-8:3, 1:2-2:1 or 1:1 of aluminium phosphate: aluminium hydroxide. Inone embodiment a ratio of 12:1-4:1, 11:1-5:1, 10:1-6:1, 9:1-7:1 or 8:1of aluminium phosphate: aluminium hydroxide is used.

Although most aluminium is provided by preadsorbed antigens beforemixture to form a combination vaccine, some aluminium may be added infree form during formulation of the combination vaccine of theinvention, e.g. before the pH adjustment step described herein.Typically, free aluminium content per 0.5 mL dose may be 0-300 μg,50-250 μg, 75-200 μg, 100-150 μg or around or exactly 115 μg of Al³⁺.Free Al³⁺ may be all Al(OH)₃ or all AlPO₄, or a mixture of Al(OH)₃ andAlPO₄ in the following ratio (w:w Al³⁺:Al³⁺): 1:1-1:6, 1:1.1-1:5,1:1.2-1:4, 1:1.3-1:3, 1:1.4-1:2, e.g. 23/92 or 69/46 or 6:1-1:1,5:1-1.1:1, 4:1-1.2:1, 3:1-1.3:1, 2:1-1.4:1, e.g. 46/69 or 92/23.

Alternatively certain components of the vaccines of the invention may benot expressly adsorbed onto adjuvant, in particular aluminium salts.

IPV may be unadsorbed or adsorbed onto Al(OH)₃ or a mixture of Al(OH)₃and AlPO₄. DT may be adsorbed onto Al(OH)₃ or AlPO₄, TT may be adsorbedonto Al(OH)₃ or AlPO₄, Pw may be adsorbed onto or mixed with AlPO₄, PRNmay be adsorbed onto Al(OH)₃, FHA may be adsorbed onto Al(OH)₃, PT maybe adsorbed onto Al(OH)₃, HB may be adsorbed onto AlPO₄, Hib may beadsorbed onto AlPO₄ or unadsorbed, Men ACWY may be adsorbed onto Al(OH)₃or AlPO₄ or unadsorbed, MenB component may be adsorbed onto Al(OH)₃ orAlPO₄ or unadsorbed, Vi may be adsorbed onto Al(OH)₃ or AlPO₄ orunadsorbed, HepA may be adsorbed onto Al(OH)₃ or AlPO₄.

Antigens which are preadsorbed onto an aluminium salt can be preadsorbedindividually prior to mixing. In another embodiment, a mix of antigensmay be preadsorbed prior to mixing with further adjuvants. In oneembodiment, IPV may be adsorbed separately or as a mixture of IPV types1, 2 and 3 or when mixed with adsorbed D and T components.

The meaning of “adsorbed antigen” is for example taken to mean greaterthan 20%, 30%, 40%, 50%, 60%, 70%, 80%, or 90% adsorbed.

The meaning of the terms “aluminium phosphate” and “aluminium hydroxide”as used herein includes all forms of aluminium hydroxide or aluminiumphosphate which are suitable for adjuvanting vaccines. For example,aluminium phosphate can be a precipitate of insoluble aluminiumphosphate (amorphous, semi-crystalline or crystalline), which can beoptionally but not exclusively prepared by mixing soluble aluminiumsalts and phosphoric acid salts. “Aluminium hydroxide” can be aprecipitate of insoluble (amorphous, semi-crystalline or crystalline)aluminium hydroxide, which can be optionally but not exclusivelyprepared by neutralising a solution of aluminium salts. Particularlysuitable are the various forms of aluminium hydroxide and aluminiumphosphate gels available from commercial sources for example, Alhydrogel(aluminium hydroxide, 3% suspension in water) and Adjuphos (aluminiumphosphate, 2% suspension in saline) supplied by Brenntag Biosector(Denmark).

Non-Immunological Components of Vaccines of the Invention

Vaccines of the invention will typically, in addition to the antigenicand adjuvant components mentioned above, comprise one or more“pharmaceutically acceptable carriers or excipients”, which include anyexcipient that does not itself induce the production of antibodiesharmful to the individual receiving the composition. Suitable excipientsare typically large, slowly metabolised macromolecules such as proteins,saccharides, polylactic acids, polyglycolic acids, polymeric aminoacids, amino acid copolymers, sucrose (Paoletti et al., 2001, Vaccine,19:2118), trehalose (WO 00/56365), lactose and lipid aggregates (such asoil droplets or liposomes). Such carriers are well known to those ofordinary skill in the art. The vaccines may also contain diluents, suchas water, saline, glycerol, etc. Additionally, auxiliary substances,such as wetting or emulsifying agents, pH buffering substances, and thelike, may be present. Sterile pyrogen-free, phosphate bufferedphysiologic saline is a typical carrier. A thorough discussion ofpharmaceutically acceptable excipients is available in referenceGennaro, 2000, Remington: The Science and Practice of Pharmacy, 20^(th)edition, ISBN:0683306472.

Compositions of the invention may be lyophilised or in aqueous form,i.e. solutions or suspensions. Liquid formulations of this type allowthe compositions to be administered direct from their packaged form,without the need for reconstitution in an aqueous medium, and are thusideal for injection. Compositions may be presented in vials, or they maybe presented in ready filled syringes. The syringes may be supplied withor without needles. A syringe will include a single dose of thecomposition, whereas a vial may include a single dose or multiple doses(e.g. 2 doses). In one embodiment the dose is for human. In a furtherembodiment the dose is for an adult, adolescent, toddler, infant or lessthan one year old human and may be administered by injection.

Liquid vaccines of the invention are also suitable for reconstitutingother vaccines from a lyophilised form. Where a vaccine is to be usedfor such extemporaneous reconstitution, the invention provides a kit,which may comprise two vials, or may comprise one ready-filled syringeand one vial, with the contents of the syringe being used toreconstitute the contents of the vial prior to injection.

Vaccines of the invention may be packaged in unit dose form or inmultiple dose form (e.g. 2 doses). For multiple dose forms, vials arepreferred to pre-filled syringes. Effective dosage volumes can beroutinely established, but a typical human dose of the composition forinjection has a volume of 0.5 mL.

In one embodiment, vaccines of the invention have a pH of between 6.0and 8.0, in another embodiment vaccines of the invention have a pH ofbetween 6.3 and 6.9, e.g. 6.6±0.2. Vaccines may be buffered at this pH.Stable pH may be maintained by the use of a buffer. If a compositioncomprises an aluminium hydroxide salt, a histidine buffer may be used(WO03/009869). The composition should be sterile and/or pyrogen free.

Compositions of the invention may be isotonic with respect to humans.

Vaccines of the invention may include an antimicrobial, particularlywhen packaged in a multiple dose format. Thiomersal should be avoided asthis leads to loss of potency of the IPV component. Other antimicrobialsmay be used, such as 2-phenoxyethanol or parabens (methyl, ethyl, propylparabens). Any preservative is preferably present at low levels.Preservative may be added exogenously and/or may be a component of thebulk antigens which are mixed to form the composition (e.g. present as apreservative in pertussis antigens).

In one embodiment, vaccines of the invention are thiomersal free orsubstantially thiomersal free. By “thiomersal free” or “substantiallythiomersal free” it is meant that there is not enough thiomersal presentin the final formulation to negatively impact the potency of the IPVcomponent. For instance, if thiomersal is used during the Pw orHepatitis B surface antigen purification process it should besubstantially removed prior to mixture with IPV. Thiomersal content inthe final vaccine should be less than 0.025 μg/μg protein, 0.024 μg/μgprotein, 0.01 μg/μg protein or 0.001 μg/μg protein, for instance 0 μg/μgprotein. In one embodiment, thiomersal is not added nor used in thepurification of any component. See for instance EP1307473 for HepatitisB and see above for Pw processes where killing is achieved not in thepresence of thiomersal.

Vaccines of the invention may comprise detergent e.g. a Tween(polysorbate), such as Tween 80. Detergents are generally present at lowlevels e.g. <0.01%.

Vaccines of the invention may include sodium salts (e.g. sodiumchloride) to give tonicity. The composition may comprise sodiumchloride. In one embodiment, the concentration of sodium chloride in thecomposition of the invention is in the range of 0.1 to 100 mg/mL (e.g.1-50 mg/mL, 2-20 mg/mL, 5-15 mg/mL) and in a further embodiment theconcentration of sodium chloride is 10±2 mg/mL NaCl e.g. about 9 mg/mL.

Vaccines of the invention will generally include a buffer. A phosphateor histidine buffer is typical.

Vaccines of the invention may include free phosphate ions in solution(e.g. by the use of a phosphate buffer) in order to favournon-adsorption of antigens. The concentration of free phosphate ions inthe composition of the invention is in one embodiment between 0.1 and10.0 mM, or in another embodiment between 1 and 5 mM, or in a furtherembodiment about 2.5 mM.

Properties of the Vaccines of the Invention

In one embodiment the vaccines of the invention are formulated as avaccine for in vivo administration to the host in such a way that theindividual components of the composition are formulated such that theimmunogenicity of individual components is not substantially impaired byother individual components of the composition. By not substantiallyimpaired, it is meant that upon immunisation, an antibody titre againsteach component is obtained which is more than 60%, 70%, 80% or 90%, or95-100% of the titre obtained when the antigen is administered inisolation. Thus, in preferred embodiments, no (significantly)detrimental effect occurs to the further components (in terms ofprotective efficacy) in the combination as compared to theiradministration in isolation.

Vaccine Formulations

In one embodiment, the vaccines of the invention are formulated as avaccine for in vivo administration to the host, such that they confer anantibody titre superior to the criterion for seroprotection for eachantigenic component for an acceptable percentage of human subjects. Thisis an important test in the assessment of a vaccine's efficacythroughout the population. Antigens with an associated antibody titreabove which a host is considered to be seroconverted against the antigenare well known, and such titres are published by organisations such asWHO. In one embodiment, more than 80% of a statistically significantsample of subjects is seroconverted, in another embodiment more than 90%of a statistically significant sample of subjects is seroconverted, in afurther embodiment more than 93% of a statistically significant sampleof subjects is seroconverted and in yet another embodiment 96-100% of astatistically significant sample of subjects is seroconverted.

The amount of antigen in each vaccine dose is selected as an amountwhich induces an immunoprotective response without significant, adverseside effects in typical vaccines. Such amount will vary depending onwhich specific immunogens are employed. Generally it is expected thateach dose will comprise 1-1000 μg of total immunogen, or 1-100 μg, or1-40 μg, or 1-5 μg. An optimal amount for a particular vaccine can beascertained by studies involving observation of antibody titres andother responses in subjects. A primary vaccination course may include2-3 doses of vaccine, given one to two months apart, e.g. following theWHO recommendations for DTP immunisation (i.e. in first year of life).Booster doses may follow in the second and/or subsequent year(s) oflife.

Polio Potency as Measured by Seroneutralisation Test on Rats

For the purposes of the invention, the assay for the IPV quantitativeevaluation of the vaccine potency of the IPV containing vaccines of theinvention should be carried out using a single dose of vaccine andshould be done by determining the ratio of test vaccine geometric meantitre (GMT) to reference vaccine GMT and is reported as the relativeresponse (RR) or relative potency (RP). Reference GMT may be the GMTobtained with any IPV vaccine comprising 40-8-32 D-antigen units of IPVtypes 1-2-3 respectively, and may be the GMT obtained with the knownvaccine Poliorix®. Typically, the RP test is carried out by as follows:

The potency of poliovirus Types 1, 2 and 3 is determined on rats byseroneutratisation:

Groups of 10 healthy rats (Sprague-Dawley (OFA) or any beforehandvalidated strain) are inoculated intramuscularly with dilutions (1/1.25;1/3.125; 1/7.81) of the test samples or reference material in phosphatebuffer saline. If necessary, the dilution range may be extended to 4dilutions by inoculating undiluted vaccine and the three previousmentioned dilutions. Ten rats inoculated with the diluent are used asnegative controls. Rats are observed once a week to detect any abnormalreaction. 20 to 22 days after the inoculation, each animal is deeplyanesthetized, and bled and the serum is collected to be analysed byseroneutralisation test.

For the seroneutralisation test, sera are inactivated by incubation at56° C. for 30 minutes in a water bath. Three dilution series of thesera, one for each polio type, are prepared in microplates using theappropriate dilution medium. Plates are stored at +4° C.

For the three polio virus types, a predetermined amount of virus (30-300CCID₅₀) is added to the sera dilutions. The three virus suspensions arediluted taking into account their respective titers. The final dilutionis called ‘working dilution’. Each working dilution is added to thecorresponding microplates. Plates are then sealed and incubated at 37°C.±1° C. for 16 hours. Hep-2 cells are then added and microplates areincubated at 37° C.±1° C. for 7 days. The cytopathogenic effect (CPE) ofthe virus is read using an inverted microscope after Coomassie bluecoloration. The presence of anti-poliomyelitis antibodies inhibits thegrowth of the virus and the appearance of the corresponding CPE. Theanti-polio virus titers (type 1, 2 and 3) correspond to the reciprocalof the last dilution without any CPE. In each group, animals withneutralising antibodies are recorded and the antibodies titer of eachserum sample is determined for the different type of poliovirus. Theneutralizing antibody titer is expressed as the log₂ of the inverse ofthe highest dilution of the serum sample that totally inhibits thecytopathic effect of poliovirus on Hep-2 cells.

The geometric mean titer per dilution (GMT) and per virus type is alsodetermined for each group of rats.

Packaging of Vaccines of the Invention

Vaccines of the invention can be packaged in various types of containere.g. in vials, in syringes, etc. A multidose vial will typicallycomprise a re-sealable plastic port through which a sterile needle canbe inserted to remove a dose of vaccine, which reseals once the needlehas been removed.

The vaccine may be supplied in various containers (e.g. 2 or 3). Thecontents of the containers may be mixed extemporaneously beforeadministering to a host in a single injection or may be administeredconcomitantly at different sites. The dose of the vaccine or eachvaccine if a kit is administered concomitantly (in two or morecontainers) will typically be 0.5 mL.

In one embodiment of this aspect of the invention there is provided akit comprising two multi-valent vaccines for conferring protection in ahost against disease caused by poliovirus, Bordetella pertussis,Clostridium tetani, Corynebacterium diphtheriae and optionally one ormore of Hepatitis B, Haemophilus influenza type B, Neisseriameningitidis type A, Neisseria meningitidis type C, Neisseriameningitidis type W, Neisseria meningitidis type Y, Neisseriameningitidis type B, Salmonella typhi, Hepatitis A or Malaria.

The kit comprises a first container comprising:

(1)

-   -   (a) Inactivated polio virus (IPV) of the invention,    -   (b) diphtheria toxoid (DT or D) (see above),    -   (c) tetanus toxoid (TT or T) (see above),    -   (d) killed whole-cell Bordetella pertussis (Pw) or 2 or more        acellular pertussis components (Pa) (see above),    -   (e) optionally Hepatitis B surface antigen (HepB or HB) (see        above),    -   (f) optionally a conjugate of a carrier protein and the capsular        saccharide of H. influenzae type B (Hib) (see above),    -   (g) optionally either or both conjugates of a carrier protein        and a capsular saccharide of a N. meningitidis type A (MenA)        or N. meningitidis type C (MenC) (see above), and        a second container comprising:

(2A)

-   -   (a) conjugates of a carrier protein and a capsular saccharide N.        meningitidis type A (MenA), N. meningitidis type C (MenC), N.        meningitidis type W (MenW) and/or N. meningitidis type Y (MenY)        (see above for various Men saccharide combinations of the        invention), and    -   (b) optionally a conjugate of a carrier protein and the capsular        saccharide of H. influenzae type B (Hib); or

(2B)

-   -   (a) a conjugate of a carrier protein and the capsular saccharide        of H. influenzae type B (Hib), and    -   (b) optionally a conjugate of a carrier protein and Vi        saccharide of Salmonella typhi

The kit may optionally comprise a third container comprising:

(3)

-   -   (a) optionally Hepatitis B surface antigen    -   (b) optionally a conjugate of a carrier protein and Vi        saccharide of Salmonella typhi

The containers may in either case additionally comprise HepA antigen(s)and/or MenB antigen(s) and/or RTS,S and/or Streptococcus pneumoniaantigen(s).

In either case, the same antigen should not be present in bothcontainers.

In one embodiment the first container has in addition to components a),b), c), d) also e), f), g), e)+f), e)+g), f)+g) or e)+f)+g).

In one embodiment the vaccine of the first container may be liquid andthe vaccine of the second container may be either liquid or lyophilised(e.g. in the presence of a known stabilising excipient such as sucroseor trehalose).

The containers of the kit can be packaged separately or, optionally,packed together. In one embodiment, the kit is provided with a list ofinstructions for administration of the vaccines in the two or morecontainers.

In one embodiment, where a container in a kit contains a certainsaccharide conjugate, the same conjugate is not present in the othercontainers of the kit.

The inventors believe that a kit provided in the above way mayadvantageously present the various antigens to a host's immune system inan optimal manner. The kit may provide a medical practitioner with anoptimal method of immunising a host with one or more of the followingadvantages: protective efficacy for all antigens, minimalreactogenicity, minimal carrier suppression interference, minimaladjuvant/antigen interference, or minimal antigen/antigen interference.In such a way, these goals may be achieved with the minimum number (two)administrations, optionally occurring at the same visit to thepractitioner.

In one embodiment the vaccines of the first and second containers areadministered concomitantly at different sites (as described below under“administration of vaccines of the invention), and in an alternativeembodiment the inventors envision that the contents of the first andsecond containers may be mixed (optionally extemporaneously) beforeadministration as a single vaccine.

Preparing Vaccines of the Invention

The present invention also provides a method for producing a vaccineformulation comprising the step of mixing the components of the vaccinetogether with a pharmaceutically acceptable excipient.

In one embodiment of the present invention there is provided a vaccineas herein described for use in a medicament for the treatment orprevention of diseases caused by infection by poliovirus and optionallyBordetella pertussis, Clostridium tetani, Corynebacterium diphtheriae,Hepatitis B virus, Haemophilus influenzae, Neisseria meningitidis typeA, Neisseria meningitidis type C, Neisseria meningitidis type W,Neisseria meningitidis type Y, Salmonella typhi or Hepatitis A.

In another embodiment of the invention there is provided a use of thevaccines of the invention in the manufacture of a medicament for thetreatment or prevention of diseases caused by infection by poliovirusand optionally Bordetella pertussis, Clostridium tetani, Corynebacteriumdiphtheriae, Hepatitis B virus, Haemophilus influenzae, Neisseriameningitidis type A, Neisseria meningitidis type C, Neisseriameningitidis type W, Neisseria meningitidis type Y, Salmonella typhi orHepatitis A.

Additionally, a method of immunising a human host against disease causedby poliovirus and optionally Bordetella pertussis, Clostridium tetani,Corynebacterium diphtheriae, Hepatitis B virus, Haemophilus influenzae,Neisseria meningitidis type A, Neisseria meningitidis type C, Neisseriameningitidis type W, Neisseria meningitidis type Y, Salmonella typhi orHepatitis A, which method comprises administering to the host animmunoprotective dose of the vaccine of the invention is also provided.

The amount of antigen in each vaccine dose is selected as an amountwhich induces an immunoprotective response without significant, adverseside effects in typical vaccines. Such amount will vary depending uponwhich specific immunogen is employed and how it is presented. In oneembodiment each dose will comprise 0.1-100 μg of saccharide, in anotherembodiment each dose will comprise 0.1-50 μg, in a further embodimenteach dose will comprise 0.1-10 μg, in yet another embodiment each dosewill comprise 1 to 5 μg saccharide.

In one embodiment, the content of protein antigens in the vaccine willbe in the range 1-100 μg, in another embodiment the content of theprotein antigens in the vaccines will be in the range 5-50 μg, in afurther embodiment the content of the protein antigens in the vaccineswill be in the range 5-25 μg.

Vaccine preparation is generally described in Vaccine Design [“Thesubunit and adjuvant approach” (eds Powell M. F. & Newman M. J.) (1995)Plenum Press New York]. Encapsulation within liposomes is described byFullerton, U.S. Pat. No. 4,235,877. Conjugation of proteins tomacromolecules is disclosed, for example by Likhite, U.S. Pat. No.4,372,945 and by Armor et al., U.S. Pat. No. 4,474,757. Use of Quil A isdisclosed by Dalsgaard et al., 1977, Acta Vet Scand. 18:349. 3D-MPL isavailable from Ribi immunochem, USA and is disclosed in British PatentApplication No. 2220211 and U.S. Pat. No. 4,912,094. QS21 is disclosedin U.S. Pat. No. 5,057,540.

In a further embodiment of the invention there is provided amulti-valent vaccine comprising inactivated poliovirus (IPV) of theinvention and optionally killed whole-cell Bordetella pertussis (Pw),tetanus toxoid (TT), diphtheria toxoid (DT), a conjugate of a carrierprotein and the capsular saccharide of H. influenzae type B(Hib—optionally conjugated to TT, DT or CRM197), wherein the amount ofconjugate per 0.5 mL dose of bulk vaccine is 1-8 μg, and theimmunogenicity of the conjugate is equivalent or improved over suchcompositions comprising larger amounts of conjugate. Optionally,Hepatitis B surface antigen may also be included.

In one embodiment the amount of conjugate per 0.5 mL dose of bulkvaccine is less than 10 μg (of saccharide in the conjugate), in anotherembodiment the amount of conjugate is 1-7, in another embodiment theamount of conjugate is 2-6 μg, or in a further embodiment about 2.5, 3,4 or 5 μg.

It will be appreciated that certain components, for example DTPwcomponents, can be combined separately before adding the adsorbed HBsAgor other components.

A method of making vaccines of the invention is also provided comprisingthe step of mixing IPV type 1, IPV type 2 and/or IPV type 3 with apharmaceutically acceptable excipient. A typical process for preparingbulk vaccine of the invention with further antigens will add the IPVcomponents to a mixture of the D and T components, i.e. the DTcomponents are mixed with the IPV components. This order of mixingallows the ionic strength and/or pH of the composition to be adjusted(e.g. pH<7) prior to the addition of the Pa or Pw components. Typically,HB pre-adsorbed onto AlPO₄ is added first if included in thecomposition, followed by the addition of DT pre-adsorbed onto Al(OH)₃ orAlPO₄, followed by the addition of TT pre-adsorbed onto Al(OH)₃ orAlPO₄, followed by the addition of IPV optionally pre-adsorbed ontoAl(OH)₃, prior to pH adjustment to e.g. pH5.9-7.2, or pH6-7, orpH6.2-6.8, or pH6.4-6.6, and then the addition of Pw pre-adsorbed ontoAlPO₄. Optionally, Hib, Vi, MenA, MenC, MenW, Men Y, MenB and/or HepAantigens may be added at any point in this process. In one embodiment,Hib, Vi, MenA, MenC, MenW, Men Y, MenB and/or HepA antigens are addedprior to pH adjustment. In one embodiment one or more antigens of theinvention are adsorbed onto aluminium phosphate or aluminium hydroxideor a mixture of both. In another embodiment the antigens of theinvention are mixed with a pharmaceutically acceptable excipient and/oradjuvant(s).

In one embodiment, the vaccine composition of the invention may beprepared in the following order: preadsorbed HBsAg is added, followed bypreadsorbed Diphtheria toxoid, followed by preadsorbed tetanus toxoidand IPV, the pH is then adjusted to approximately 6.5 prior to addingpreadsorbed Pw.

In another embodiment, the vaccine composition of the invention may beprepared in the following order: preadsorbed tetanus toxoid is added,followed by IPV, followed by preadsorbed HBsAg, followed by preadsorbedDiphtheria toxoid, the pH is then adjusted to approximately 6.5 prior toadding preadsorbed Pw.

In general, the combined vaccine compositions according to any aspect ofthe invention can be prepared as follows: The IPV, DTPw, HepB, MenA,MenC, MenW, MenY, MenB, Vi, Hepatitis A or other components arepre-adsorbed onto a suitable adjuvant, especially aluminium hydroxide oraluminium phosphate or a mixture of both. After allowing time forcomplete and stable adsorption of the respective components, thedifferent components are combined under appropriate conditions. The Hib,Vi, MenA, MenC, MenW and/or MenY conjugate(s) may or may not be adsorbedonto aluminium adjuvant salt before being mixed with the DTPw vaccine.

In one embodiment, vaccines of the invention are prepared at between 15°C. and 30° C. (e.g. between 19° C. and 27° C., or at 23±4° C.).

Administration of Vaccines of the Invention

The invention provides a method for raising an immune response in amammal, comprising the step of administering an effective amount of avaccine of the invention. The vaccines can be administeredprophylactically (i.e. to prevent infection). The immune response ispreferably protective and preferably involves antibodies. The method mayraise a booster response.

Following an initial vaccination, subjects may receive one or severalbooster (subsequent) immunisations adequately spaced. Dosing treatmentcan be a single dose schedule or a multiple dose schedule. Multipledoses may be used in a primary immunisation schedule and/or in a boosterimmunisation schedule. A primary dose schedule, which may be in thefirst year of life, may be followed by a booster dose schedule. Suitabletiming between priming doses (e.g. between 4-16 weeks), and betweenpriming and boosting can be routinely determined.

In one embodiment, the mammal is a human. Where the vaccine is forprophylactic use, the human is preferably a child (e.g. a toddler ofinfant) or a teenager; where the vaccine is for therapeutic use, thehuman is preferably an adult. A vaccine intended for children may alsobe administered to adults e.g. to assess safety, dosage, immunogenicity,etc.

The vaccine preparations of the present invention may be used to protector treat a mammal susceptible to infection, by means of administeringsaid vaccine directly to a patient. Direct delivery may be accomplishedby parenteral administration (intramuscularly, intraperitoneally,intradermally, subcutaneously, intravenously, or to the interstitialspace of a tissue); or by rectal, oral, vaginal, topical, transdermal,intranasal, ocular, aural, pulmonary or other mucosal administration. Inone embodiment, administration is by intramuscular injection to thethigh or the upper arm. Injection may be via a needle (e.g. a hypodermicneedle), but needle free injection may alternatively be used. A typicalintramuscular dose is 0.5 mL.

Bacterial infections affect various areas of the body and so thecompositions of the invention may be prepared in various forms. Forexample, the compositions may be prepared as injectables, either asliquid solutions or suspensions. The composition may be prepared forpulmonary administration e.g. as an inhaler, using a fine powder orspray. The composition may be prepared as a suppository or pessary. Thecomposition may be prepared for nasal, aural or ocular administratione.g. as spray, drops, gel or powder (see e.g. Almeida & Alpar, 1996, JDrug Targeting, 3:455; Bergquist et al., 1998, APMIS, 106:800).Successful intranasal administration of DTP vaccines has been reported(Ryan et al., 1999, Infect. Immun., 67:6270; Nagai et al., 2001,Vaccine, 19:4824).

In one embodiment the vaccines of the first and second (and third whereapplicable) containers are administered concomitantly at differentsites, and in an alternative embodiment the inventors envision that thecontents of the first and second containers may be mixed (optionallyextemporaneously) before administration as a single vaccine.

The invention may be used to elicit systemic and/or mucosal immunity.

One way of checking the efficacy of therapeutic treatment involvesmonitoring bacterial infection after administration of the compositionof the invention. One way of checking efficacy of prophylactic treatmentinvolves monitoring immune responses against the antigens afteradministration of the composition. Immunogenicity of compositions of theinvention can be determined by administering them to test subjects (e.g.children 12-16 months age, or animal models—WO 01/30390) and thendetermining standard immunological parameters. These immune responseswill generally be determined around 4 weeks after administration of thecomposition, and compared to values determined before administration ofthe composition. Rather than assessing actual protective efficacy inpatients, standard animal and in vitro models and correlates ofprotection for assessing the efficacy of DTP vaccines are well known.

The terms “comprising”, “comprise” and “comprises” herein are intendedby the inventors to be optionally substitutable with the terms“consisting of”, “consist of” and “consists of”, respectively, in everyinstance. This does not change the normal meaning of these terms, and isonly intended to provide basis for the substitution, not to make themequivalent in meaning.

All cited references and publications are incorporated by referenceherein.

EXAMPLES

Examples are provided solely for the purposes of illustration and arenot intended to limit the scope of the invention.

Example 1 Tests on low dose IPV formulations

For all the formulations of the example 1, the antigens are adsorbed byaddition of aluminium salt prior to formulation except IPV which isadded without adsorption.

The tables below present the adsorption method for D, T, Pw and HBsAg.

TABLE 1 Method of productions for Diphtheria toxoid adsorption.

FINAL COMPOSITION per dose Diphtheria 7.5 Lf (+/−420 Lf/ml) Al³⁺ 0.075mg NaCl   150 mM pH 6.1 +/− 0.1 Volume approximately 18 μl

TABLE 2 Method of productions for Tetanus toxoid adsorption.

FINAL COMPOSITION per dose Tetanus 3.25 Lf (+/−360 Lf/ml) Al³⁺ 0.070 mgNaCl   150 mM pH 6.1 +/− 0.1 Volume approximately 9 μl

TABLE 3 Method of productions for Pw adsorption

FINAL COMPOSITION per dose Antigens Adjuvant [Al³⁺] (mg) Pw   20 OUAlPO4 0.170 mg Al³⁺ 0.170 mg AlPO4 NaCl   150 mM pH    6.8    Volumeapproximately 65 μl

TABLE 4 Method of productions for HBsAg adsorption

FINAL COMPOSITION per dose Antigens Adjuvant [Al³⁺] (mg) HBsAg   10 μgAlPO₄ 0.200 mg Al³⁺ 0.200 mg AlPO₄ NaCl   150 mM pH 6.1 +/− 0.1 Volumeapproximately 50 μl

Several different formulations were tested:

-   -   A combination of Diptheria toxoid, Tetanus toxoid, Pertussis        whole cell and Hepatitis B surface antigen: DTPw_(SF)-HB as a        reference (DTPw_(SF) means that it is a thiomersal free        formulation), formulated with the production method 1 (table 5).    -   GlaxoSmithKline Biologicals S.A. product Poliorix® (IPV        stand-alone not adsorbed) as unadsorbed reference at the        standard dose, formulated with the production method 2 (table        5).    -   A combination of Diphtheria toxoid, Tetanus toxoid, Pertussis        whole cell, Hepatitis B surface antigen and Inactivated polio        virus: DTPw_(SF)-HB-IPV with addition of the IPV before Pw,        formulated with the production method 3 (table 5).    -   A combination of Diphtheria toxoid, Tetanus toxoid, Pertussis        whole cell, Hepatitis B surface antigen and Inactivated polio        virus: DTPw_(SF)-HB-IPV with addition of the IPV just after T        adsorbed. This addition method allows IPV adsorption onto        Al(OH)₃. This vaccine is formulated with the production method 4        (table 5).

A placebo containing only aluminium salts, IPV and buffers of the othersantigens. As IPV is the only antigen in this placebo, there is nocompetition for adsorption. Therefore, IPV is completely adsorbed. Thisvaccine is formulated with the production method 5 (table 5).

The vaccines formulated with production method 2, 3, 4 and 5 wereproduced with an IPV dose-range between 12.5% and 100% of the standardIPV dose of 40/8/32 IU/0.5 mL.

TABLE 5 Method of productions per 0.5 mL dose Step Method of production1: DTPw_(SF)-HB 1 Water for injection to reach a final dose volume of0.5 mL 2 Add NaCl 1.5M to reach a final concentration of 150 mM 3 Add115 μg of Al³⁺ as AlPO₄ 4 Add 10 μg of HBsAg adsorbed 5 Add 7.5 Lf ofDiphtheria toxoid adsorbed 6 Add 3.25 Lf of Tetanus toxoid adsorbed 7Stirring 8 Adjust the pH at 6.5 +/− 0.1 9 Stirring 10  Add 20 IOU Pwadsorbed 11  Stirring 12  Store at +2 to +8° C. Step Method ofproduction 2: IPV standalone 1 Add IPV at a dose of Type 1 Type 2 Type 340 IU 8 IU 32 IU 20 IU 4 IU 16 IU 10 IU 2 IU  8 IU  5 IU 1 IU  4 IU 2Add M199 buffer to reach a final volume of 0.5 mL 9 Stirring 10  Adjustthe pH at 6.9 +/− 0.2 14  Store at +2 to +8° C. Step Method ofproduction 3: DTPw_(SF)-HB-IPV 1 Water for injection to reach a finaldose volume of 0.5 mL 2 Add NaCl 1.5M to reach a final concentration of150 mM 3 Add 115 μg of Al³⁺ as AlPO₄ 4 Add 10 μg of HBsAg adsorbed 5 Add7.5 Lf of Diphtheria toxoid adsorbed 6 Add 3.25 Lf of Tetanus toxoidadsorbed 7 Stirring 8 Add IPV at a dose of Type 1 Type 2 Type 3 40 IU 8IU 32 IU 20 IU 4 IU 16 IU 10 IU 2 IU  8 IU  5 IU 1 IU  4 IU 9 Stirring10  Adjust the pH at 6.5 +/− 0.1 11  Stirring 12  Add 20 IOU Pw adsorbed13  Stirring 14  Store at +2 to +8° C. Step Method of production 4:DTPw_(SF)-HB-IPV 1 Water for injection to reach a final dose volume of0.5 mL 2 Add NaCl 1.5M to reach a final concentration of 150 mM 3 Add3.25 Lf of Tetanus toxoid adsorbed 4 Add IPV at a dose of Type 1 Type 2Type 3 40 IU 8 IU 32 IU 20 IU 4 IU 16 IU 10 IU 2 IU  8 IU  5 IU 1 IU  4IU 5 Stirring 6 Add 115 μg of Al³⁺ as AlPO₄ 7 Add 10 μg of HBsAgadsorbed 8 Add 7.5 Lf of Diphtheria toxoid adsorbed 9 Stirring 10 Adjust the pH at 6.5 +/− 0.1 11  Stirring 12  Add 20 IOU Pw adsorbed 13 Stirring 14  Store at +2 to +8° C. Method of production 5: Placebo Asper Method of production 3, however all antigens other than IPV havebeen omitted.

For the method of production 1 formulation: HBsAg, D and T are adsorbedseparately on AlPO₄, AlPO₄ and Al(OH)₃ respectively. The three antigensare sequentially added to a suspension containing water, NaCl and freeAlPO₄. The mixture is stirred for 60-75 min. Then the pH is adjusted to6.5 before addition of adsorbed Pw.

For the method of production 3 formulation, the three adsorbed antigensare sequentially added to a suspension containing water, NaCl and freeAlPO₄. The mixture is stirred for 60-75 min before IPV addition. The pHis adjusted to 6.5 before addition of Pw antigens.

For the method of production 4 formulation, T antigen is adsorbed onAl(OH)₃. Preadsorbed T antigen is added to a suspension containing waterand NaCl, followed by IPV types 1, 2 and 3. The mixture is stirred for60-75 minutes before addition of free AlPO₄. Preadsorbed HBsAg is thenadded, followed by preadsorbed D antigen, and the mixture is thenstirred for an additional 60-75 minutes. The pH is adjusted to 6.5before addition of Pw antigens.

The method of production 3 was eventually selected due to ease ofmanufacture as this protocol only involved one stirring step. During theprocess of manufacturing the vaccine, thiomersal is not used, and is notadded to the final vaccine product.

The table below presents the composition of the formulations for a 0.5mL dose.

TABLE 6 Composition of formulations per 0.5 mL dose Al³⁺ as AlPO4 Al³⁺as Al³⁺ as AlPO4 Al³⁺ as AlPO4 for D Al(OH)3 for D for HBsAg for PwDescription adsorption adsorption adsorption adsorption Free AlPO4 FreeAl(OH)3 Method of production 1 75 μg 70 μg 200 μg 170 μg 115 μg NADTPw_(SF)-HB Method of production 2 NA NA NA NA NA NA IPV Method ofproduction 3 75 μg 70 μg 200 μg 170 μg 115 μg NA DTPw_(SF)-HB-IPV Methodof production 4 75 μg 70 μg 200 μg 170 μg 115 μg NA DTPw_(SF)-HB-IPVMethod of production 5 NA NA NA NA 560 μg 70 μg Placebo IPV dose % ofD-antigen Diphtheria Tetanus Pertussis standard units (*) Descriptiontoxoid dose toxoid dose dose HBsAg dose dose (T1/T2/T3) Method ofproduction 1 7.5 Lf 3.25 Lf 20 IOU 10 μg NA NA DTPw_(SF)-HB Method ofproduction 2 NA NA NA NA 100%  40/8/32 IPV 50% 20/4/16 25% 10/2/812.50%   5/1/4 Method of production 3 7.5 Lf 3.25 Lf 20 IOU 10 μg 100% 40/8/32 DTPw_(SF)-HB-IPV 50% 20/4/16 25% 10/2/8 12.50%   5/1/4 Method ofproduction 4 7.5 Lf 3.25 Lf 20 IOU 10 μg 100%  40/8/32 DTPw_(SF)-HB-IPV50% 20/4/16 25% 10/2/8 12.50%   5/1/4 Method of production 5 NA NA NA NA100%  40/8/32 Placebo 50% 20/4/16 25% 10/2/8 12.50%   5/1/4 (*) TheD-antigen content is the values targeted for the dilution of theconcentrated inactivated polio bulk during the formulation

Determination of Polio Potency on Rats by Seroneutralisation

The potency of the vaccine was determined by a seroneutralisation testafter intramuscular inoculation of rats (Sprague-Dawley (OFA) or anybeforehand validated strain). Groups of 10 naïve healthy rats wereinoculated intramuscularly (0.5 mL) with dilutions of the test samples,reference material in phosphate buffer saline, or diluent (phosphatebuffer saline). The ten rats inoculated with the diluent were used asnegative controls. Twenty to twenty-two days after the inoculation(immunisation period), each animal was deeply anesthetized prior toblood collection by cardiac puncture. Blood samples were centrifuged (atapproximately 800 g), and serums were analysed.

Seroneutralisation Test:

Sera were inactivated by incubation at 56° C. for 30 minutes. Threedilution series of the sera, one for each polio type, were prepared inmicroplates using the appropriate dilution medium. For the three poliovirus types, a predetermined amount of virus was added to the seradilutions. The three virus suspensions were diluted taking into accounttheir respective titers. The final dilution is called ‘workingdilution’. Each working dilution was added to the correspondingmicroplates. Plates were then sealed and incubated at 37° C.±1° C. for16 hours. Hep-2 cells were then added and microplates were incubated at37° C.±1° C. for 7 days. The cytopathogenic effect (CPE) of the viruswas read using an inverted microscope after Coomassie blue colouration.

The presence of anti-poliomyelitis antibodies inhibits the growth of thevirus and the appearance of the corresponding CPE. The anti-polio virustiters (type 1, 2 and 3) correspond to the reciprocal of the lastdilution without any CPE.

In each group, animals with neutralising antibodies are recorded and theantibodies titer of each serum sample is determined for the differenttype of poliovirus. The neutralizing antibody titer is expressed as thelog₂ of the inverse of the highest dilution of the serum sample thattotally inhibits the cytopathic effect of poliovirus on Hep-2 cells. Thegeometric mean titer per dilution (GMT) and per virus type is thendetermined for each group of rats.

For each type of virus, the vaccine dilution and subsequently the amountof D-antigen which induced neutralising antibodies in 50% of the rats(ED50) was also calculated by probit analysis. The ED50 was expressed inD-antigen units.

In order to quantify the potency relative to that of the referencevaccine (usually Poliorix®, but may be a DTPaHBIPV vaccine such asPediarix®), the relative potency (RP) defined as the ratio of twoequivalent dose responses in a multi-dose test was measured. In thisapproach, the potency of the test vaccine is calculated by parallel lineassay as described in Finney, 1978 (Statistical Method in BiologicalAssay, Charles Griffin & Company Ltd, London, 1978).

Determination of the Potency Polio Type 1, 2 and 3 by ELISA

The determination of the potency Polio by ELISA is performed in one ortwo steps depending on whether measurement is being carried out on bulkunadsorbed IPV vs formulated vaccines respectively:

1. Desorption for final adsorbed vaccine (for measuring D-antigen unitsin formulated vaccines—not required for measurement in unadsorbed IPVantigen bulk);2. ELISA test for the quantification of D-antigen content of desorbedand unadsorbed vaccine and/or polio bulk

Desorption Step

After centrifugation for 10 minutes of the adsorbed vaccine under test,three successive desorptions are performed, by adding a desorptionphosphate buffer to the pellet, mixing and incubating at roomtemperature. The first and the second desorption periods are of 2 hours,the incubation period for the third extraction being one night at roomtemperature. The harvests from the three extractions are pooled anddiluted with phosphate buffer solution (PBS) without Ca and Mgcontaining bovine serum albumine (BSA) and Tween 20.

The three poliovirus antigens are quantified by ELISA as describedbelow.

D-Antigen Quantification by ELISA:

Microtiter plates are coated with specific rabbit anti-polio virus (type1, 2 or 3) IgG, diluted with carbonate/bicarbonate buffer (pH 9.6), andincubated overnight at 4° C. After washing, the saturating solution(phosphate buffer saline w/o Ca and Mg+1% BSA) is added. Blanks (PBS)and serial dilutions of vaccine samples and in-house unadsorbed standardare added in duplicate. The in house trivalent standard preparationcontains calibrated type 1, 2 and 3 antigens. The calibrator is theEuropean Pharmacopoeia Biological reference (EPBRP).

For all following steps, the microtiter plates are incubated during 1h30 at 37° C. and washed. Rabbit anti-polio virus (type 1, 2 or 3) IgGconjugated to peroxydase, diluted with phosphate buffer (w/o Ca andMg+Tween 20) containing BSA, is added. The substrate solution,containing the tetramethylbenzidine dissolved in dimethyl sulfoxyde(DMSO) and diluted in acetate buffer containing 0.003% H₂O₂, is added,followed by a 15-30 minutes incubation in the dark. The blockingsolution, containing H₂SO₄, is then added. Within one hour, the opticaldensity (O.D.) of each well is read using a photometer set at 450 nmwith a reference at 620 nm.

The D-antigen concentration in test samples is calculated from thestandard curve obtained by plotting the O.D. values against the standardantigen concentrations.

As a supplement to the Potency by ELISA, any unadsorbed IPV antigen maybe detected by the completeness method:

Completeness of Adsorption to Adjuvant Unbound Polio Type 1, 2 and 3 byElisa

Two successive centrifugations are performed. The supernatant is thenharvested and tested undiluted in duplicate on microplates by ELISA.Microtiter plates are coated with specific rabbit anti-polio virus (type1, 2 or 3) IgG, diluted with carbonate/bicarbonate buffer (pH 9.6), andincubated overnight at 4° C. After washing, the saturating solution(phosphate buffer saline w/o Ca and Mg+1% BSA) is added. Blanks (PBS),supernatant and in-house unadsorbed standard are added in duplicate.

For all following steps, the microtiter plates are incubated during 1h30 at 37° C. and washed. Rabbit anti-polio virus (type 1, 2 or 3) IgGconjugated to peroxydase, diluted with phosphate buffer (w/o Ca andMg+Tween 20) containing BSA, is added. The substrate solution,containing the tetramethylbenzidine dissolved in dimethyl sulfoxyde(DMSO) and diluted in acetate buffer containing 0.003% H₂O₂, is added,followed by a 15-30 minutes incubation in the dark. The blockingsolution, containing H₂SO₄, is then added. Within one hour, the opticaldensity (O.D.) of each well is read using a photometer set at 450 nmwith a reference at 620 nm.

The completeness is considered positive (antigen in the supernatant) ifthe mean OD of sample is higher than the mean OD values of blanks+3standard deviations and if the mean OD of sample is higher than 0.1.

In case of positive completeness, the antigen content is measured byELISA method as described in the second step of the Potency Polio Type1, 2 and 3 by ELISA.

Method of Measuring International Opacity Unit (IOU)

Cell concentration (IOU) can be determined using either visual IRPO(International Reference Preparation of Opacity) standard solution or byabsorbance measurement at 660 nm.

The opacity of Single Strain Suspension is then determined by applyingthe “assigned opacity” equation as follows:

AO=LO/KO×CO;

where AO=assigned opacity, LO=live harvest opacity, KO=killed harvestopacity, and CO=concentrate opacity.

Results Determination of Potency Polio on Rats by Seroneutralisation atthe Standard 40:8:32 Dose

Experiments were performed to determine the potency of IPV types 1, 2and 3. Results are shown in Table 8 below (in the present document,40:8:32 D-antigen units of IPV types 1, 2 and 3 respectively isequivalent to 100% IPV dose).

TABLE 8 Potency of IPV types 1, 2 and 3 in three different vaccineformulations. Potency IPV (ED50 expressed in IU/dose) Decription Type 1Type 2 Type 3 Ref. Poliorix 20.78 8.88 40.02 Ref. DTPaHBIPV 3.21 0.578.62 DTPw_(SF)-HB-IPV <1.93 0.64 <2.57 Method of production 3

The DTPw_(SF)-HB-IPV formulation (100% IPV) presents IPV potenciesbetter than the reference Poliorix and similar or better than thereference DTPaHBIPV.

Evaluation of IPV Potency with Reduced IPV Dosages

The potency is measured by in vitro and in vivo methods described above.

The potency by Elisa of reduced dose IPV for both formulations ofmethods of production 3 and 4 was examined in vitro and compared withreference DTPaIPVHB as shown in Table 9. Two batches for eachformulation were tested for method of production 3.

The percentage of recovery was calculated with regard to the antigencontent taken from IPV bulk for each formulation (e.g. 40/8/32 for 100%IPV containing formulation; 20/8/16 for 50% IPV containing formulation;10/4/8 for 25% IPV containing formulation; 5/2/4 for 12.5 IPV containingformulation)

TABLE 9 T1 T2 T3 Potency Completness Potency Completness PotencyCompletness Polio (% (% Polio (% (% Polio (% (% Sample Recovery)Recovery) Recovery) Recovery) Recovery) Recovery) DTPaIPVHB Reference82% NP 99% NP 93% NP DTPwSF-HB-IPV 1 “Method of Production 3” 100% IPV46% 47% 94% <5% 24% 74% DTPwSF-HB-IPV 2 “Method of Production 3” 100%IPV 80% <5% 100% <5.0%   81% 17% DTPwSF-HB-IPV 1 “Method of Production3” 50% IPV 48% 31% 98% <5% 29% 64% DTPwSF-HB-IPV 2 “Method of Production3” 50% IPV 71% <5% 99% <5% 91% >5% DTPwSF-HB-IPV 1 “Method of Production3” 25% IPV 54% 34% 115% <5% 33% 71% DTPwSF-HB-IPV 2 “Method ofProduction 3” 25% IPV 81% <5% 115% <5% 107% <5% DTPwSF-HB-IPV “Method ofProduction 3” 12.5% IPV 50% 24% 110% <5% 28% 60% DTPwSF-HB-IPV “Methodof Production 4” 100% IPV 41% 48% 93% <5% 23% 51% DTPwSF-HB-IPV “Methodof Production 4” 50% IPV 47% 37% 98% <5% 28% 69% DTPwSF-HB-IPV “Methodof Production 4” 25% IPV 51% 28% 80% <5% 33% 61% DTPwSF-HB-IPV “Methodof Production 4” 12.5% IPV 42% 22% 100% <5% 40% 58% Placebo “Method ofproduction 5” 100% IPV 86% <5% 98% <5% 107% <5% Placebo “Method ofproduction 5” 50% IPV 94% <5% 110% <5% 111% <5% Placebo “Method ofproduction 5” 25% IPV 80% <5% 100% <5% 104% <5% Placebo “Method ofproduction 5” 12.5% IPV 72% <5% 100% <5% 98% <5%

Table 9 show that the adsorption completeness is similar for all IPVdoses. The Type 1 and Type 3 are strongly desorbed (17%-74%) while theType 2 stay well adsorbed. The three types are well adsorbed for theplacebo formulation for all the IPV doses. The adsorption is similar asfor DTPaIPVHB reference vaccine.

There is a variability IPV completeness because of the fact that thecompleteness quantification method is not validated neither for DTPwHBIPV formulations nor for lower IPV concentrations (<40/8/32 D-antigenUnits/0.5 ml).

The relative potency (expressed in comparison with reference poliorixvaccine) of reduced dose IPV for both formulations of methods ofproduction 3 and 4 was examined in vivo in comparison with referenceformulations as shown in FIGS. 1 and 2. Two batches for eachformulations were tested for method of production 3.

FIG. 1 shows that the IPV potency of DTPwSF-HB-IPV with 100% IPV isslightly greater than the potency of IPV in DTPaHBIPV. The IPV potencyof DTPwSF-HB-IPV 50% from the formulation of method of production 3 canbe seen to be similar to DTPaHBIPV 100%. The IPV potency forDTPwSF-HB-IPV 25% of method of production 3 is slightly lower than forPoliorix®. It was also found that 12.5% of the IPV dose was notsufficient to obtain a good IPV potency.

FIG. 2 shows that the IPV potency is similar for the formulation ofmethod of production 3 and the formulation of method of production 4. Itis also shown that there is a trend of better potency for the placebothan for DTPwSF-HB-IPV.

These data therefore confirm that a reduced dose of IPV is sufficient toobtain a good potency in vivo.

Example 2 Feasibility of Using No Thiomersal in Vaccines of theInvention

The Preservative Efficacy Test (PET) allows the demonstration of theantimicrobial activity of the tested vaccine. The test consists in:

-   -   challenging the vaccine preparation, in its final container        step, with a prescribed inoculum of suitable micro-organisms,    -   storing the inoculated preparation at a prescribed temperature    -   withdrawing samples from the container at specified intervals of        time and counting the organisms in the taken samples.

The PET testing procedure is described in the European Pharmacopoeia(5.1.3) and in the USP (<51>). According to these guidelines, theantimicrobial activity is evaluated by comparing the reduction in thenumber of viable micro-organisms with the criteria mentioned in thefollowing table (Table 7)

TABLE 7 EP and USP Criteria Criteria: log reduction Microorganisms TimeEP A EP B EP C USP Bacteria Staphylococus aureus 6 h 2 Escherichia colid1 3 1 Ni* Pseudomonas aeruginosa d7 3 Ni* 1 d14 3 3 d28 Nr* Ni* Ni* Ni*Yeast and moulds Candida albicans d7 2 Ni* Aspergillus niger d14 1 Ni*Ni* d28 Ni* Ni* Ni* Ni* Nr*: not recovered Ni*: not increased

Example 3 Effect of Hib Component on the Potency of IPV and Stability ofIPV Over Time

Relative potency of IPV was measured as described in Example 1 todetermine the effects the Hib component may have on IPV potency and toevaluate the stability of IPV over time at different IPV doses. Thevaccines investigated were DTPwHBIPV(40-8-32), DTPwHBIPV withreconstituted Hib and stored for 8 months, DTPwHBIPV(20-4-16),DTPwHBIPV(20-4-16) with reconstituted Hib and stored for 8 months,DTPwHBIPV(20-4-16) and stored for 8 months, DTPwHBIPV(10-2-8) andDTPwHBIPV(10-2-8) with reconstituted Hib and stored for 8 months. RPvalues were measure relative to DTPaIPVHB (Pediarix) (FIG. 3 a) orPoliorix (FIG. 3 b). It was found that the Hib component has no impacton IPV potency. The relative potency of IPV was found to be maintainedat 8 months (FIG. 3).

Example 4 Effect of AlPO4/Al(OH)3 Ratio on the Visual Aspect, theAdsorption of D and T and the Potency of IPV

Formulations were performed with change of Aluminium composition.

The formulations DTPw_(SF)-HB-IPV usually contains 630 μg Aluminium: 560μg Al³⁺ as AlPO4, 70 μg Al3+ as Al(OH)₃. Aluminium salts are used toadsorb D, T, Pw and HBsAg. 115 μg Al³⁺ of free AlPO₄ is added during theformulation.

Formulations were performed with the following ratios of free Al³⁺:

TABLE 10 AlPO4/Al(OH)3 ratio Al(OH)3 AlPO4 μg Al3+ μg Al3+ Lot 1 0 115Lot 2 23 92 Lot 3 69 46 Lot 4 46 69 Lot 5 92 23 Lot 6 115 0

TABLE 11 Method of production for DTPwHB-IPV Step Method of production3: DTPw_(SF)-HB-IPV 1 Water for injection to reach a final dose volumeof 0.5 mL 2 Add NaCl 1.5M to reach a final concentration of 150 mM 3 Add115 μg of Al³⁺ with at the different ratios Al(OH)₃/AlPO₄ 4 Add 10 μg ofHBsAg adsorbed 5 Add 7.5 Lf of Diphtheria toxoid adsorbed 6 Add 3.25 Lfof Tetanus toxoid adsorbed 7 Stirring 8 Add IPV at a dose of 40/8/32 IU9 Stirring 10 Adjust the pH at 6.5 +/− 0.1 11 Stirring 12 Add 20 IOU Pwadsorbed 13 Stirring 14 Store at +2 to +8° C.

Visual aspect was observed and up to ratio 69/46, acceptable aggregationis obtained.

Formulations were performed with the same production method and adose-range for IPV between 0 and 100% of the regular IPV dose.

The percentage of D and T toxoids adsorption was measured by ELISA. Thestability of the adsorption was followed by a treatment of 7 days at 37°C. Results are presented in Table 12 and 14.

TABLE 12 Percentage of D toxoid desorption in DTPwHB-IPV with IPVdose-range RATIO Al(OH)₃/AlPO₄ IPV 0/115 23/92 46/69 dose T0 7 d 37° C.T0 7 d 37° C. T0 7 d 37° C. Pw_(SF) 0% <1% 25% <1% 6% / 25% <1% 29% <1%15% <1% 5% 50%  3% 41% <1% 26% <1% 17% 100%  4% 49% <1% 23% <1% 11%

TABLE 13 Percentage of T toxoid desorption in DTPwHB-IPV with IPVdose-range RATIO Al(OH)₃/AlPO₄ 0/115 23/92 46/69 IPV dose T0 7 d 37° C.T0 7 d 37° C. T0 7 d 37° C. Pw_(SF) 0% <1% 34% <1 12% / 25% <1% 50% <132% <1% 12% 50%  5% 61% <1 51% <1% 33% 100%  8% 63% <1 41% <1% 29%

IPV adsorption was followed. The stability of the adsorption wasfollowed by a treatment of 21 days at 25° C.

TABLE 14 Percentage of IPV desorption in DTPwHB-IPV with IPV dose-rangeEstimation of Ag not adsorbed RATIO Al(OH)3/AlPO4 IPV 0/115 23/92 46/69Dose Type T0 21 d 25° C. T0 21 d 25° C. T0 21 d 25° C. 0% N/A N/A N/AN/A N/A AGGREGATION 25% Type 1 ~10-20% ~20-30% ~10-20% ~20-30% <10%~20-30% Type 2 <10% <10% <10% <10% <10% <10% Type 3 >30% >30%~20-30% >30% <10% >30% 50% Type 1 >30% >30% ~10-20% >30% ~10-20% >30%Type 2 ~10-20% ~10-20% <10% <10% <10% <10% Type 3 >30% >30% ~10-20% >30%~10-20% >30% 100% Type 1 >30% >30% ~10-20% >30% ~10-20% >30% Type 2~10-20% ~10-20% <10% <10% <10% <10% Type 3 >30% >30% ~20-30% >30%~20-30% >30%

The increase of the Al(OH)₃ content in the formulations allows anadsorption improvement for D, T and IPV.

The better adsorption ratio obtained was with the Al(OH)₃/AlPO₄ ratio of46/69.

At this ratio:

-   -   The T and D adsorption is complete in T0. Desorption after an        accelerated stability study of 7 days at 37° C. present <20% of        desorption for D, <30% for T.    -   Each IPV type is adsorbed. Desorption of the Type 3 occurs 21        days at 25° C.

The formulations with the ratio 46/69 were tested in-vivo and comparedwith Tetravac, Poliorix and a DTPaIPV vaccine.

TABLE 15 In-vivo potencies results ED50 Sample Type 1 Type 2 Type 3DTPw-HB-IPV <1.93 <0.64 2.57 100%/HIB Ratio 46/69 DTPw-HB-IPV <1.59 0.46<1.67 50%/HIB Ratio 46/69 DTPw-HB-IPV 3.08 0.96 3.25 25%/HIB Ratio 46/69Tetravac 8.53 0.39 9.15 Poliorix 9.52 2.64 15.06 DTPaHBIPV <5.18 <0.6415.01

There are no significant differences (ED50) between the DTPw-HB-IPVformulations. DTPaHBIPV, Tetravac and Poliorix give similar results,inferior to the DTPw-HB-IPV formulations (except for the type 2 forwhich all the formulations are equivalent).

Example 5 Clinical Evaluation of the Investigational DTPw-HBV-IPV/HibVaccine with Reduced IPV Dosages

A Phase II, feasibility study is planned to assess the immunogenicity,reactogenicity and safety of three different formulations of GSKBiologicals' investigational DTPw-HBV-IPV/Hib vaccine as compared to thecommercial DTPw-HBV/Hib and IPV vaccines administered concomitantly.

Indication/Populations:

Primary immunization of healthy infants in the first week of lifeagainst diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis andHaemophilus influenzae type b diseases.

Study Groups:

-   -   DTPw-HBV-IPV(standard dose)/Hib vaccine    -   DTPw-HBV-IPV(49% of standard dose)/Hib vaccine    -   DTPw-HBV-IPV(26% of standard dose)/Hib vaccine    -   DTPw-HBV/Hib+IPV vaccines

Co-Primary Objectives:

The co-primary objectives will be assessed in sequential manner: i.e.the second and third objectives will be assessed only if the precedingone has been met.

-   -   To demonstrate the non-inferiority of the DTPw-HBV-IPV(standard        dose)/Hib vaccine to the IPV vaccine co-administered with the        DTPw-HBV/Hib vaccine in terms of antibody response to the three        poliovirus types, one month after the primary vaccination        course.    -   The objective of non-inferiority will be reached if the upper        limit of the standardised asymptotic 95% CI on the difference        between groups (DTPw-HBV/Hib+IPV minus DTPw-HBV-IPV(standard        dose)/Hib) in terms of seroprotection rates for each of the        three poliovirus types is <10%.    -   To demonstrate the non-inferiority of the DTPw-HBV-IPV(49% of        standard dose)/Hib vaccine to the IPV vaccine co-administered        with the DTPw-HBV/Hib vaccine in terms of antibody response to        the three poliovirus types, one month after the primary        vaccination course.    -   The objective of non-inferiority will be reached if the upper        limit of the standardised asymptotic 95% CI on the difference        between groups (DTPw-HBV/Hib+IPV minus DTPw-HBV-IPV(49% of        standard dose)/Hib) in terms of seroprotection rates for each of        the three poliovirus types is ≦10%.    -   To demonstrate the non-inferiority of the DTPw-HBV-IPV (26% of        standard dose)/Hib vaccine to the IPV vaccine co-administered        with the DTPw-HBV/Hib vaccine in terms of antibody response to        the three poliovirus types, one month after the primary        vaccination course.    -   The objective of non-inferiority will be reached if the upper        limit of the standardised asymptotic 95% CI on the difference        between groups (DTPw-HBV/Hib+IPV min us DTPw-HBV-IPV(26% of        standard dose)/Hib) in terms of seroprotection rates for each of        the three poliovirus types is ≦10%.

Secondary Objectives:

Immunogenicity

To assess the immunogenicity the DTPw-HBV-IPV/Hib candidate vaccine interms of response to all vaccine antigens in comparison with theDTPw-HBV/Hib and IPV vaccines co-administered.

Reactogenicity

To assess the reactogenicity and safety of the study vaccines, in termsof solicited symptoms, unsolicited symptoms and serious adverse events.

Vaccination Schedule

Three-dose primary vaccination schedule at 6, 10 and 14 weeks of age.All subjects receive a birth dose of Hepatitis B.

Country:

Philippines

Blood Sampling:

Pre- and post-vaccination 3

Vaccine Formulations:

TABLE 16 Vaccine formulations Vaccine Formulation/dose PresentationVolume GSK Biologicals' DTPw- Diphtheria toxoid: not less than 30 IU(7.5 Lf) Whitish liquid in 0.5 ml of the HBV-IPV/Hib Tetanus toxoid: notless than 60 IU (3.25 Lf) monodose vials reconstituted Bordetellapertussis, killed: not less than 4 IU (20 OU) vaccine r-DNA HBsAg: 10 μgAluminium as salts: 0.66 mg IPV component (standard InactivatedPoliovirus type 1: 40 D antigen units dose) Inactivated Poliovirus type2: 8 D antigen units Inactivated Poliovirus type 3: 32 D antigen unitsIPV component (49% of 49% of full standard dose IPV (40-8-32) standarddose) IPV component (26% of 26% of full standard dose IPV (40-8-32)standard dose) Conjugate of Haemophilus influenzae type b capsularFreeze-dried polysaccharide: 2.5 μg pellet in and Tetanus toxoid: 5-10μg monodose vials Lactose: 12.6 mg Aluminium as salts: 30 μg GSKBiologicals' DTPw- Diphtheria toxoid: not less than 30 IU (7.5 Lf)Whitish liquid in   1 ml of the HBV/Hib (Zilbrix ™ Hib) Tetanus toxoid:not less than 60 IU (3.25 Lf) two-dose vials reconstituted Bordetellapertussis, killed: not less than 4 IU (20 OU) vaccine r-DNA HBsAg: 10 μgAluminium as salts: 0.66 mg Thiomersal: 8 μg Conjugate of Haemophilusinfluenzae type b capsular Freeze-dried polysaccharide: 2.5 μg andTetanus toxoid: 5-10 μg pellet in two- Lactose: 12.6 mg dose vialsAluminium as salts: 30 μg GSK Biologicals' IPV Inactivated Poliovirustype 1: 40 D antigen units Whitish liquid 0.5 ml (Poliorix ™)Inactivated Poliovirus type 2: 8 D antigen units in monodose InactivatedPoliovirus type 3: 32 D antigen units vials 2-phenoxyethanol max 2.5 mgPolysorbate max 50 μg Formaldehyde max 100 μg Phosphate buffered salineContains amino acids for injection q.s, ad 0.5 ml

Pre-Adsorption of the Antigens

The DTPw-HBV-IPV formulation combines diphtheria toxoid, tetanus toxoid,three Bordetella pertussis strains, the purified major surface antigen(HBsAg) of the Hepatitis B virus (HBV) and the inactivated polio virus(IPV). These antigens, except IPV, were first pre-adsorbed on aluminiumsalt before being mixed with aluminium salt, sodium chloride buffer andwater for injection.

Adsorption of Diphtheria Toxoid

The diphtheria purified concentrate was adsorbed on aluminium phosphatein a ratio of 15 Lf Diphtheria toxoid/0.15 mg Al₃₊. The two componentswere stirred for 15 up to 45 minutes at room temperature. The pH wasadjusted to pH 5.1±0.1, followed by stirring for 15 up to 45 minutes.The mix was stored for one week at 37° C. After stirring of 15 up to 45minutes at room temperature, the pH was adjusted to pH 6.1±0.1. Theadsorbed concentrate was stored at +2° C.-+8° C. for at least 7 daysbefore final formulation of DTPw-HB-IPV vaccine. FIG. 1 hereafterhighlights the adsorption manufacturing process of the pre-adsorbedDiphtheria bulk.

Adsorption of Tetanus Toxoid

The purified tetanus concentrate was adsorbed on aluminium hydroxide ina ratio of 3.25 Lf/0.07 mg Al³⁺. The two components were stirred for 15up to 20 minutes. The pH was adjusted at pH 6.1±0.1. The mix was storedunder stirring for 16 up to 24 hours at room temperature. A sodiumchloride solution of 1500 mM of nominal concentration was added (ad 150mM). After stirring of 15 up to 45 minutes at room temperature, the pHwas adjusted to 6.1±0.1. The adsorbed concentrate was stored at +2°C.-+8° C. for at least 14 days before final formulation of DTPw-HBV-IPVvaccine.

Adsorption of Hepatitis B Antigen

The sterile purified HBsAg bulk was mixed with a sterile suspension ofaluminium phosphate in order to obtain a suspension which contains per10 μg HBsAg, 0.2 mg Al³⁺ (as aluminium phosphate), 150 mM NaCl in afinal volume of about 50 μl.

Adsorption of Pw Antigen

The AlPO₄ solution was transferred aseptically into a sterile vessel.The solution was stirred for 5 to 10 minutes and the pH was adjusted to6.5+/−0.1 with 1M HCl or 0.5M NaOH directly in the vessel. The solutionwas stirred for 15-20 minutes. The pH was checked (6.5+/−0.1) andadjusted if necessary.

Before the adsorption, the pertussis pooled harvest (PPH) was mixed fora minimum of 15 minutes prior to use and then the PPH was added into thesterile vessel containing the AlPO₄. The suspension was stirred forminimum 15 minutes at room temperature and could be stored overnight atroom temperature. If the product was stored overnight at roomtemperature, it had to be resuspended for minimum 30 minutes beforedistribution. Samples were taken for testing.

The Pw adsorbed bulk was distributed into sterile glass bottles andstored at 2-8° C.

DTPW-HBV-IPV Final Formulation

The process was done as follows:

-   -   The sodium chloride solution and water were mixed for injections        in order to achieve a final concentration of 150 mM NaCl.    -   AlPO₄ was added in order to obtain a free A11+ concentration of        0.115 mg/dose    -   The adsorbed HEF, diphtheria and tetanus concentrates were added        in order to obtain a final concentration of 10 μg of HBsAg, 7.5        Lf diphtheria toxoid and 3.25 Lf tetanus toxoid per 0.5 ml dose.    -   IPV was added in order to obtain a final concentration of        40/8/32 or 19.6/3.9/15.7 or 10.4/2.1/8.3 UI/d.    -   Stirring gently for 60 up to 120 minutes at room temperature.    -   pH was adjusted at 6.5+/−0.1    -   Stirring for 15 up to 20 minutes at room temperature.    -   pH was checked: 6.5+/−0.1    -   Adsorbed Pw concentrate was added in order to obtain a final        concentration of 20 IOU per 0.5 ml dose    -   Stirring for 15 to 45 minutes at room temperature.    -   pH was measured    -   The final bulk was stored between +2° C. and +8° C. until        filling.

Example 6 Clinical Evaluation of the Investigational DTPa-HBV-IPV/HibVaccine with Reduced Hib and IPV Dosages

A Phase II, exploratory study is planned to assess the immunogenicity,reactogenicity and safety of 4 different formulations of GSKBiologicals' investigational DTPa-HBV-IPV/Hib vaccine versus thecommercial DTPa-HBV-IPV/Hib vaccine and the commercial DTPw-HBV/Hib andIPV vaccines administered concomitantly.

Indication/Populations:

Primary immunization of healthy infants in the first week of lifeagainst diphtheria, tetatus, pertussis, hepatitis B, poliomyelitis andHaemophilus influenzae type b diseases.

Study Groups:

-   -   DTPa-HBV-IPV(49% of standard dose)/Hib 5 μg vaccine    -   DTPa-HBV-IPV(49% of standard dose)/Hib 2.5 μg vaccine    -   DTPa-HBV-IPV(26% of standard dose)/Hib 5 μg vaccine    -   DTPa-HBV-IPV (26% of standard dose)/Hib 2.5 μg vaccine    -   DTPa-HBV-IPV/Hib vaccine    -   DTPw-HBV/Hib+IPV vaccines

Primary Objectives:

To assess the immunogenicity of the DTPa-HBV-IPV/Hib candidate vaccinesin terms of the response to the PRP and the three polio antigens (polio1, 2 and 3).

Secondary Objectives:

Immunogenicity

To assess the immunogenicity of all study vaccines in terms of responseto all vaccine antigens.

Reactogenicity

To assess the reactogenicity and safety of the study vaccines, in termsof solicited symptoms, unsolicited symptoms and serious adverse events.

Vaccination Schedule

Three-dose primary vaccination schedule as of 6 weeks of age. Allsubjects receive a birth dose of Hepatitis B.

Country:

TBC

Blood Sampling:

Pre- and Post-Vaccination 3

Vaccine Formulations:

The vaccine is constituted of two parts: a liquid part (DTPa-HB-IPV) anda freeze dried part (Hib).

D, T, PT, FHA, PRN and HBsAg are preliminary pre-adsorbed. Water andNaCl are blended with the different antigens. The mixture is stirred tohomogenize and pH is adjusted. The final composition of the DTPa-HB-IPVpart of the vaccine is presented in the table hereafter.

TABLE 17 Composition for one 0.5 mL human dose of DTPa-HBV-IPV ComponentAmount D toxoid 25 Lf T toxoid 10 Lf PT 25 μg FHA 25 μg PRN  8 μg HBsAg10 μg IPV type 1 40 or 19.6 or 10.4 IU IPV type 2  8 or 3.9 or 2.1 IUIPV type 3 32 or 15.7 or 8.3 IU Al³⁺ From 700 to 790 μg

Hib is pre-adsorbed. The Hib pre-adsorbed is mixed with sucrose orlactose prior to freeze drying. The Hib amount will be 2.5 or 5 or 10 μgper human dose. Aluminium content will be from 30 to 120 μg Al³⁺ asAlPO₄ per human dose.

1. A method of making a vaccine (i.e. a combination vaccine) comprisinginactivated poliovirus type 1, comprising the steps of: mixingdiphtheria toxoid and tetanus toxoid, followed by the addition ofinactivated poliovirus type 1 at a dose greater than 10 D-antigen unitsand less than 20 D-antigen units and optionally IPV type(s) 2 and/or 3(IPV).
 2. A method of making a vaccine (i.e. a combination vaccine)comprising inactivated poliovirus type 1, comprising the steps of:mixing diphtheria toxoid and tetanus toxoid, followed by the addition ofinactivated poliovirus type 1 at an amount greater than 10 D-antigenunits and less than 20 D-antigen units per 0.5 mL and optionally IPVtype(s) 2 and/or 3 (IPV).
 3. The method of claim 1 or 2, wherein thevaccine comprises inactivated poliovirus type 1 at 26-49%, 30-45%,33-40%, or 35-37% of a standard 40 D-antigen unit dose.
 4. The method ofclaim 1 or 2, wherein the vaccine comprises inactivated poliovirus type1 at 26-49%, 30-45%, 33-40%, or 35-37% of a standard 40 D-antigen unitdose per 0.5 mL.
 5. The method of claims 1-4, wherein the vaccineadditionally comprises inactivated poliovirus type 3 at a dose of 8-20D-antigen units, 9-19 D-antigen units, 10-18 D-antigen units, 11-17D-antigen units, 12-16 D-antigen units, or 13-15 D-antigen units; forinstance around or exactly 14 D-antigen units.
 6. The method of claims1-4, wherein the vaccine additionally comprises inactivated poliovirustype 3 at an amount of 8-20 D-antigen units, 9-19 D-antigen units, 10-18D-antigen units, 11-17 D-antigen units, 12-16 D-antigen units, or 13-15D-antigen units per 0.5 mL; for instance around or exactly 14 D-antigenunits per 0.5 mL.
 7. The method of claim 5 or 6, wherein the vaccinecomprises inactivated poliovirus type 3 at a dose of greater than 8 andless than 20 D-antigen units.
 8. The method of claim 5 or 6, wherein thevaccine comprises inactivated poliovirus type 3 at an amount of greaterthan 8 and less than 20 D-antigen units per 0.5 mL.
 9. A method ofmaking a vaccine (i.e. a combination vaccine) comprising inactivatedpoliovirus type 3, comprising the steps of: mixing diphtheria toxoid andtetanus toxoid, followed by the addition of inactivated poliovirus type3 at a dose of greater than 8 and less than 20 D-antigen units, 9-19D-antigen units, 10-18 D-antigen units, 11-17 D-antigen units, 12-16D-antigen units, or 13-15 D-antigen units; for instance around orexactly 14 D-antigen units and optionally IPV type(s) 1 and/or 3 (IPV).10. A method of making a vaccine (i.e. a combination vaccine) comprisinginactivated poliovirus type 3, comprising the steps of: mixingdiphtheria toxoid and tetanus toxoid, followed by the addition ofinactivated poliovirus type 3 at an amount of greater than 8 and lessthan 20 D-antigen units, 9-19 D-antigen units, 10-18 D-antigen units,11-17 D-antigen units, 12-16 D-antigen units, or 13-15 D-antigen unitsper 0.5 mL; for instance around or exactly 14 D-antigen units per 0.5 mLand optionally IPV type(s) 1 and/or 3 (IPV).
 11. The method of claim 9or 10, wherein the vaccine additionally comprises inactivated poliovirustype 1 at a dose of 10-20 D-antigen units, 11-19 D-antigen units, 12-18D-antigen units, 13-17 D-antigen units, 14-16 D-antigen units; forinstance around or exactly 15 D-antigen units.
 12. The method of claim 9or 10, wherein the vaccine additionally comprises inactivated poliovirustype 1 at an amount of 10-20 D-antigen units, 11-19 D-antigen units,12-18 D-antigen units, 13-17 D-antigen units, 14-16 D-antigen units per0.5 mL; for instance around or exactly 15 D-antigen units per 0.5 mL.13. The method of claims 1-12, wherein the vaccine additionallycomprises inactivated poliovirus type 2 at a dose of 2-4 D-antigenunits.
 14. The method of claims 1-12, wherein the vaccine additionallycomprises inactivated poliovirus type 2 at an amount of 2-4 D-antigenunits per 0.5 mL.
 15. The method of claim 13 or 14, wherein the vaccinecomprises inactivated poliovirus type 2 at a dose greater than 2D-antigen units and less than 4 D-antigen units, or at a dose around orexactly 3 D-antigen units.
 16. The method of claim 13 or 14, wherein thevaccine comprises inactivated poliovirus type 2 at an amount greaterthan 2 D-antigen units and less than 4 D-antigen units per 0.5 mL, or atan amount of around or exactly 3 D-antigen units per 0.5 mL.
 17. Themethod of claims 1-16, wherein the relative potency value of the vaccineis at least 0.85, 0.9, 0.95 or 1 when compared to a vaccine comprising40 D-antigen units of IPV type
 1. 18. The method of claims 1-17, whereinthe relative potency value of the vaccine is at least 0.85, 0.9, 0.95 or1 when compared to a vaccine comprising 8 D-antigen units of IPV type 2.19. The method of claims 1-18, wherein the relative potency value of thevaccine is at least 0.85, 0.9, 0.95 or 1 when compared to a vaccinecomprising 32 D-antigen units of IPV type
 3. 20. The method of claims1-19, comprising the subsequent step of adjusting pH to 6.5±0.5, orpH5.9-7.2, or pH6-7, or pH6.2-6.8, or pH6.4-6.6.
 21. The method ofclaims 1-20, comprising the subsequent steps of adding a killedwhole-cell or acellular pertussis component(s) and a pharmaceuticallyacceptable excipient, optionally where free aluminium phosphate ispresent prior to the addition of the antigens.
 22. The method of claims1-21, comprising the additional step of adding Hepatitis B surfaceantigen prior to pH adjustment or prior to the addition of IPV.
 23. Themethod of claims 1-22, comprising the additional step of mixing one ormore antigens from a pathogen selected from a list consisting of:Haemophilus influenzae b, Neisseria meningitidis type A, Neisseriameningitidis type C, Neisseria meningitidis type W, Neisseriameningitidis type Y, Neisseria meningitidis type B, Salmonella typhi andHepatitis A, with diphtheria toxoid, tetanus toxoid, inactivatedpoliovirus types 1, 2 and/or 3 and optionally Hepatitis B surfaceantigen prior to pH adjustment.
 24. A method of making a DTP vaccinewhich is substantially thiomersal free and which comprises one or moreIPV components selected from the group consisting of: a. IPV type 1 at adose of 10-36 D-antigen units, 11-32 D-antigen units, 12-28 D-antigenunits, 13-24 D-antigen units, 14-20 D-antigen units or 15-19 D-antigenunits, or around or exactly 18 D-antigen units; b. IPV type 2 at a doseof 2-7 D-antigen units, 3-6 D-antigen units, or 4-5 D-antigen units; andc. IPV type 3 at a dose of 8-29 D-antigen units, 9-26 D-antigen units,10-23 D-antigen units, 11-20 D-antigen units, 12-17 D-antigen units, or13-14 D-antigen units, comprising the steps of: mixing diphtheria toxoidand tetanus toxoid, followed by the addition of inactivated polioviruscomponent(s).
 25. The method of claim 24, wherein the vaccine comprisesinactivated poliovirus type 1 at a dose of 10-36 D-antigen units, 11-32D-antigen units, 12-28 D-antigen units, 13-24 D-antigen units, 14-20D-antigen units or 15-19 D-antigen units, or around or exactly 18D-antigen units.
 26. The method of claim 24 or 25, wherein the vaccinecomprises inactivated poliovirus type 2 at a dose of 2-7 D-antigenunits, 3-6 D-antigen units, or 4-5 D-antigen units.
 27. The method ofclaims 24-26, wherein the vaccine comprises inactivated poliovirus type3 at a dose of 8-29 D-antigen units, 9-26 D-antigen units, 10-23D-antigen units, 11-20 D-antigen units, 12-17 D-antigen units, or 13-14D-antigen units.
 28. The method of claims 1-27, wherein the vaccinecomprises inactivated poliovirus type 1 adsorbed onto aluminiumhydroxide, or aluminium phosphate, or a mixture of both (whereinadsorption takes place either before mixing with antigen other than IPV,or wherein adsorption takes place after mixing with antigen other thanIPV).
 29. The method of claim 28, wherein the IPV type 1 is added priorto the pH adjustment step of claim
 20. 30. The method of claims 1-29,wherein the vaccine comprises inactivated poliovirus type 2 adsorbedonto aluminium hydroxide, or aluminium phosphate, or a mixture of both(wherein adsorption takes place either before mixing with antigen otherthan IPV, or wherein adsorption takes place after mixing with antigenother than IPV).
 31. The method of claim 30, wherein the IPV type 2 isadded prior to the pH adjustment step of claim
 20. 32. The method ofclaims 1-31, wherein the vaccine comprises inactivated poliovirus type 3adsorbed onto aluminium hydroxide, or aluminium phosphate, or a mixtureof both (wherein adsorption takes place either before mixing withantigen other than IPV, or wherein adsorption takes place after mixingwith antigen other than IPV).
 33. The method of claim 32, wherein theIPV type 3 is added prior to the pH adjustment step of claim
 20. 34. Themethod of claims 1-33, wherein the vaccine comprises IPV types 1, 2 and3 adsorbed onto an aluminium salt (wherein adsorption takes place eitherbefore mixing with antigen other than IPV, or wherein adsorption takesplace after mixing with antigen other than IPV).
 35. The method ofclaims 1-34, wherein the vaccine comprises IPV types 1, 2 and 3 adsorbedonto aluminium hydroxide or aluminium phosphate or a mixture of both(wherein adsorption takes place either before mixing with antigen otherthan IPV, or wherein adsorption takes place after mixing with antigenother than IPV).
 36. The method of claims 1-35, wherein the vaccinecomprises diphtheria toxoid, optionally adsorbed onto aluminiumhydroxide, or aluminium phosphate, or a mixture of both (whereinadsorption takes place either before or after mixing with otherantigens).
 37. The method of claim 36, wherein the diphtheria toxoid isadded prior to the pH adjustment step of claim
 20. 38. The method ofclaims 1-37, wherein the vaccine comprises tetanus toxoid, optionallyadsorbed onto aluminium hydroxide, or aluminium phosphate, or a mixtureof both (wherein adsorption takes place either before or after mixingwith other antigens).
 39. The method of claim 38, wherein the tetanustoxoid is added prior to the pH adjustment step of claim
 20. 40. Themethod of claims 1-39, wherein the vaccine comprises killed whole cellBordetella pertussis (Pw), optionally adsorbed onto aluminium hydroxide,or aluminium phosphate, or a mixture of both (wherein adsorption takesplace either before or after mixing with other antigens).
 41. The methodof claim 40, wherein the Pw is added after the pH adjustment step ofclaim
 20. 42. The method of claim 41, wherein the killed whole-cellBordetella pertussis is adsorbed onto aluminium phosphate (whereinadsorption takes place either before or after mixing with otherantigens).
 43. The method of claim 42, wherein the Pw is added after thepH adjustment step of claim
 20. 44. The method of claims 1-43, whereinthe vaccine comprises two or more acellular pertussis components (Pa)(e.g. pertussis toxoid (PT), filamentous haemagglutinin (FHA) andpertactin (PRN)), optionally adsorbed onto aluminium hydroxide, oraluminium phosphate, or a mixture of both (wherein adsorption takesplace either before or after mixing with antigens other than acellularpertussis antigens).
 45. The method of claim 44, wherein the Pa is addedafter the pH adjustment step of claim
 20. 46. The method of claim 45,wherein the two or more acellular pertussis components (Pa) are adsorbedonto aluminium phosphate (wherein adsorption takes place either beforeor after mixing with antigens other than acellular pertussis antigens).47. The method of claim 46, wherein the Pa is added after the pHadjustment step of claim
 20. 48. The method of claims 1-47, wherein thevaccine comprises Hepatitis B surface antigen, optionally adsorbed ontoaluminium phosphate (wherein adsorption takes place either before orafter mixing with other antigens).
 49. The method of claim 48, whereinthe Hepatitis B surface antigen is added prior to the pH adjustment stepof claim
 20. 50. The method of claims 1-49, wherein the vaccinecomprises a conjugate of a carrier protein and the capsular saccharideof Haemophilus influenzae type B (Hib), optionally adsorbed ontoaluminium phosphate or unadsorbed onto adjuvant (wherein adsorptiontakes place either before or after mixing with other antigens).
 51. Themethod of claim 50, wherein the Hib is added prior to the pH adjustmentstep of claim
 20. 52. The method of claims 1-51, wherein the vaccinecomprises one or more conjugates of a carrier protein and a capsularsaccharide of a bacterium selected from the group Neisseria meningitidistype A, Neisseria meningitidis type C, Neisseria meningitidis type W andNeisseria meningitidis type Y, optionally adsorbed onto aluminiumhydroxide or aluminium phosphate or a mixture of both or unadsorbed ontoadjuvant (wherein adsorption takes place either before or after mixingwith antigens other than Neisseria meningitidis type A, C, W or Ycapsular saccharide antigens).
 53. The method of claim 52, wherein theone or more conjugates of a carrier protein and a capsular saccharide ofa bacterium selected from the group Neisseria meningitidis type A,Neisseria meningitidis type C, Neisseria meningitidis type W andNeisseria meningitidis type Y are added prior to the pH adjustment stepof claim
 20. 54. The method of claims 1-53, wherein the vaccinecomprises a Neisseria meningitidis type B (MenB) outer membrane vesicleor LOS or a conjugated MenB capsular saccharide, or derivative thereof,optionally adsorbed onto aluminium hydroxide or aluminium phosphate or amixture of both or unadsorbed onto adjuvant (wherein adsorption takesplace either before or after mixing with antigens other than MenBantigens).
 55. The method of claim 55, wherein the MenB outer membranevesicle or LOS or the conjugated MenB capsular saccharide is added priorto the pH adjustment step of claim
 20. 56. The method of claims 1-55,wherein the vaccine comprises a Vi saccharide from Salmonella typhiconjugated to a carrier protein, optionally adsorbed onto aluminiumhydroxide or aluminium phosphate or a mixture of both or unadsorbed ontoadjuvant (wherein adsorption takes place either before or after mixingwith other antigens).
 57. The method of claim 56, wherein the Visaccharide from Salmonella typhi conjugated to a carrier protein isadded prior to the pH adjustment step of claim
 20. 58. The method ofclaims 1-57, wherein the vaccine comprises an antigen from Hepatitis A,optionally adsorbed onto aluminium hydroxide or aluminium phosphate or amixture of both (wherein adsorption takes place either before or aftermixing with other antigens).
 59. The method of claim 58, wherein theantigen from Hepatitis A is added prior to the pH adjustment step ofclaim
 20. 60. The method of claims 1-59, wherein the vaccine comprisesDT at an amount of 5-50, 7-30 Lf or approximately or exactly 7.5 Lf or25 Lf per 0.5 mL dose.
 61. The method of claims 1-59, wherein thevaccine comprises DT at an amount of less than 5 Lf, or 1-4 Lf orapproximately or exactly 2 Lf per 0.5 mL dose.
 62. The method of claims1-61, wherein the vaccine comprises TT at an amount of 2.5-30 Lf, 3-20Lf, 5-15 Lf or exactly or approximately 10 Lf per 0.5 mL dose.
 63. Themethod of claims 1-62, wherein Pa, if present in the vaccine, comprisesPT at an amount of 2-50 μg, 5-40 μg, 10-30 μg or exactly orapproximately 25 μg per 0.5 mL dose.
 64. The method of claims 1-63,wherein the vaccine comprises Pa which comprises PT at an amount ofexactly or approximately 2.5 or 8 μg per 0.5 mL dose.
 65. The method ofclaims 1-64, wherein the vaccine comprises Pa which comprises FHA at anamount of 2-50 μg, 5-40 μg, 10-30 μg or exactly or approximately 25 μgper 0.5 mL dose.
 66. The method of claims 1-65, wherein the vaccinecomprises Pa which comprises FHA at an amount of exactly orapproximately 2.5 or 8 μg per 0.5 mL dose
 67. The method of claims 1-66,wherein the vaccine comprises Pa which comprises PRN at an amount of0.5-20 μg, 0.8-15 μg, 2-10 μg or exactly or approximately 8 μg per 0.5mL dose.
 68. The method of claims 1-67, wherein the vaccine comprisesPa, which comprises PRN at an amount of exactly or around 0.8 or 2.5 μgper 0.5 mL.
 69. The method of claims 1-68, wherein the vaccine comprisesPw at an amount of 5-50 IOU, 7-40 IOU, 9-35 IOU, 11-30 IOU, 13-25 IOU,15-21 IOU or around or exactly 20 IOU per 0.5 mL dose.
 70. The method ofclaims 1-69, wherein the vaccine comprises HB at an amount of 5-20 μg,8-15 μg or approximately or exactly 10 μg per 0.5 mL
 71. The method ofclaims 1-70, wherein the vaccine comprises Hib at an amount of 5-20 μg,8-15 μg or approximately or exactly 10 μg per 0.5 mL dose.
 72. Themethod of claims 1-70, wherein the vaccine comprises Hib at an amount of1-6 μg, 2-4 μg or around or exactly 2.5 μg per 0.5 mL dose.
 73. Themethod of claims 1-72, comprising an additional step of adding anadjuvant.
 74. The method of claims 1-73, wherein the vaccine comprisesone or more adjuvants selected from the group consisting of: analuminium salt such as aluminium hydroxide or aluminium phosphate, asalt of calcium, iron or zinc, an insoluble suspension of acylatedtyrosine or acylated sugars, cationically or anionically derivatisedsaccharides, polyphosphazenes, biodegradable microspheres,monophosphoryl lipid A (MPL), lipid A derivatives of reduced toxicity,3-O-deacylated MPL, quil A, Saponin, QS21, tocol, AS-2, CpGoligonucleotides, bioadhesives, mucoadhesives, microparticles,liposomes, polyoxyethylene ether formulations, polyoxyethylene esterformulations, muramyl peptides, imidazoquinolone compounds,interleukins, macrophage colony stimulating factor (M-CSF), tumournecrosis factor (TNF), granulocyte and macrophage colony stimulatingfactor (GM-CSF).
 75. The method of claim 73, wherein the adjuvant is apreferential TH1 inducer.
 76. The method of claims 1-75, wherein totalaluminium content in the vaccine is 200-1000 μg, 300-900 μg, 400-800 μg,500-700 μg or around or exactly 630 μg Al³⁺ per 0.5 mL dose.
 77. Themethod of claim 76, wherein Al³⁺ content in the vaccine is all aluminiumhydroxide or all aluminium phosphate.
 78. The method of claim 76,wherein Al³⁺ content in the vaccine is a mixture of aluminium hydroxideand aluminium phosphate in the following ratio: 1:8-8:1, 1:4-4:1,3:8-8:3, 1:2-2:1 or 1:1 (w:w Al³⁺:Al³⁺) of aluminium phosphate:aluminiumhydroxide.
 79. The method of claim 76, wherein Al³⁺ content in thevaccine is a mixture of aluminium hydroxide and aluminium phosphate inthe following ratio 12:1-4:1, 11:1-5:1, 10:1-6:1, 9:1-7:1 or 8:1 (w:wAl³⁺:Al³⁺) of aluminium phosphate: aluminium hydroxide.
 80. The methodof claims 1-79, comprising a step of adding free aluminium salt adjuvantto the vaccine to the amount of 0-300 μg, 50-250 μg, 75-200 μg, 100-150μg or around or exactly 115 μg of Al³⁺ per 0.5 mL dose.
 81. The methodof claim 80, wherein the free aluminium salt adjuvant is all Al(OH)₃ orall AlPO₄.
 82. The method of claim 80, wherein the free aluminium saltadjuvant is a mixture of Al(OH)₃ and AlPO₄ in the following ratio (w:wAl³⁺:Al³⁺): 1:1-1:6, 1:1.1-1:5, 1:1.2-1:4, 1:1.3-1:3, 1:1.4-1:2, e.g.23/92 or 69/46.
 83. The method of claim 80, wherein the free aluminiumsalt adjuvant is a mixture of Al(OH)₃ and AlPO₄ in the following ratio(w:w Al³⁺:Al³⁺): 6:1-1:1, 5:1-1.1:1, 4:1-1.2:1, 3:1-1.3:1, 2:1-1.4:1,e.g. 46/69 or 92/23.
 84. The method of claims 80-83, wherein the freealuminium salt adjuvant is added prior to the pH adjustment step ofclaim
 20. 85. The method of any of claims 1-84, wherein IPV type 1, ifpresent in the vaccine, is the Mahoney strain.
 86. The method of any ofclaims 1-85, wherein IPV type 2, if present in the vaccine, is the MEF-1strain.
 87. The method of any of claims 1-86, wherein IPV type 3, ifpresent in the vaccine, is the Saukett strain.